乾燥性鼻炎
楊惟婷
乾燥性鼻炎(chronic rhinitis sicca)一般認為長期受外界的物理或化學物質的刺激所致，如長期粉塵的機械性刺激、空氣過熱或過乾的影響等，是一種常見的職業性、慢性鼻炎。
一、乾燥性鼻炎的病因
■乾燥性鼻炎多發生在氣候乾燥的冬、春季;
■高溫作業和在有大量粉塵環境中工作的人也容易發生乾燥性鼻炎;
■維生素（A、B2、C）缺乏可引起鼻黏膜改變，誘發乾燥性鼻炎;
■吸煙、飲酒及其他周身疾病，可使患者抵抗力減弱，易於發病。
二、乾燥性鼻炎的症状
■乾燥性鼻炎大多鼻內發乾，鼻腔分泌物減少，發癢、灼熱感，常誘使患者挖鼻，引起小量鼻出血，嗅覺一般不減退。
■鼻粘膜杯狀細胞減少或消失致鼻粘膜乾燥，但鼻粘膜和鼻甲骨均無萎縮，鼻分泌物也無臭味。因鼻、咽粘液腺體萎縮，鼻分泌減少之故，鼻涕過於粘稠，粘於粘膜上，不易擤出，有時帶血或血痂。
■鼻內有刺癢感或異物感，經常引起噴嚏，患者經常揉鼻、挖鼻，藉以減輕症状。
■粘膜乾燥，血管易於脆裂，輕微損傷，常導致出血，尤其粘膜糜爛、潰瘍或鼻中隔穿孔時，經常有血涕。
■急性鼻炎初期粘膜鮮紅充血，有粘液性分泌物。
■慢性鼻炎前鼻鏡檢查可見鼻粘膜深紅色，表面乾燥無光，鼻道有絲狀分泌物。
■鼻中隔前下區粘膜常糜爛，可有小片薄痂附著，去之常出血。
三、乾燥性鼻炎的併發症
當鼻炎未能得到及時治療，影響嗅覺粘膜時，就會出現嗅覺障礙，導致聞不著香臭等氣味。
當長期反覆發作的鼻竇炎未得到及時治療，炎症就會擴散至鄰近器官、組織，而併發如額骨骨髓炎、眶骨壁骨炎及骨膜炎、眶壁骨膜下膿腫、眶內蜂窩織炎、球後視神經炎、硬腦膜外膿腫、硬腦膜下膿腫、化膿性腦膜炎、腦膿腫、海綿竇血栓性靜脈炎等多種危重急症。
四、乾燥性鼻炎的防治方法
1、首先，增加室內濕度。
可用加濕器，或常用清水拖地，也可在室內養些植物。
2、其次，可每天做鼻部按摩。
用拇指、食指夾住鼻根兩側，用力向下拉，由上而下連拉12次。此法可促使鼻黏膜的血液循環，有利於鼻黏膜的正常分泌，保持鼻腔的濕潤。
3、感覺鼻腔乾燥時，可以將一杯開水放到口鼻處，讓蒸汽濕潤鼻腔，出門時還可戴上口罩。
4、飲食中忌食辛辣、燥熱、煎炸的刺激性食物之物，多吃些蔬菜、水果，保持大便通暢。
5、可定期滴、塗有潤澤鼻腔作用的藥劑，或感覺鼻腔乾燥時使用油劑滴鼻藥液，如復方薄荷油、鼻軟膏等。
6、適量服用魚肝油丸或維生素B2，對於預防鼻腔乾燥也有不錯的效果。
7、平時多補充一些維生素A、B2、C，有助於鼻黏膜上皮的恢復。
因為維生素B2能增強細胞功能，促進鼻黏膜纖毛的運動。
維生素C對毛細血管壁有保護作用。
8、應戒除煙酒。
五、乾燥性鼻炎的中醫治療
1、燥邪傷鼻症
■主症：鼻內乾燥、灼熱、異物感，有時鼻涕帶血。鼻粘膜乾燥，下鼻甲前端常有少許結痂，鼻中隔前下方乾紅，或有咽癢乾咳，口乾欲飲。舌質偏紅少苔，脈細略數。
■治法：清燥宣肺，養陰生津。
■治療乾燥性鼻炎方藥：清燥救肺湯(《醫門法律》霜桑葉、石膏、芝麻仁、人蔘、甘草、枇杷葉、阿膠、麥冬、杏仁)加減，方中人蔘改為沙參、鼻衄者加元參、白茅根、炒蒲黃，大便干者加郁李仁、火麻仁。
2、陰虛鼻竅失濡症
■主症：鼻內乾燥、刺癢。灼熱感，時有少量衄血，鼻粘膜乾燥，鼻中隔乾紅，有少許結痂，口燥咽乾，腰膝酸軟，舌紅少苔，脈細數。
■治療乾燥性鼻炎方藥：百合固金湯(《醫方集解》百合、生地、熟地、麥冬、當歸、白芍、川貝母、玄參、桔梗、甘草)。
3、氣虛鼻竅失養症
■主症：鼻內乾燥感、異物感、灼熱感、鼻涕帶血、鼻粘膜色淡少津，鼻中隔前方乾燥、糜爛、結痂。倦怠乏力、面色無華、納差、舌質淡、脈弱無力。
■治法：健脾益氣、升清潤燥。
■治療乾燥性鼻炎方藥：補中益氣湯(《脾胃論》黃芪、人蔘、白朮、當歸、升麻、柴胡、陳皮、甘草)加薩參、麥冬、百合等。
4、脾胃郁熱症
■主症：鼻內乾燥、鼻息氣熱。多見鼻衄、鼻粘膜干紅，鼻中隔前下方有少量結痂、糜爛，咽乾欲飲、大便乾、小便黃、舌質紅、苔黃而乾、脈滑數。
■治法：清解肺胃、生津潤燥。
■治療乾燥性鼻炎方藥：加味升葛湯(《醫學見能》升麻、葛根、白芍、甘草、連翹、銀花、天花粉、白芷、杏仁、枳殼、生地、黃芩、芒硝)。
六、乾燥性鼻炎的西醫護理
(一)去除病因。
如降塵、降溫、通風等改善環境條件，加強個人保護，如戴口罩、沖洗鼻腔等措施。
■對於乾燥性鼻炎，不要經常用手挖鼻，以免損傷鼻黏膜，每天應清洗鼻腔，將結痂浸軟，取出。
(二) 鼻腔可用油劑滴鼻藥液。如復方薄荷油、液體石蠟或鼻軟膏。
■應注意勿用血管收縮劑。
■可鼻內滴用生理鹽水、5%葡萄糖鹽水、液體石蠟、1%~3%碳酸氫鈉、稀釋甘油等，上述藥物可根據情況任選一種。一般認為5%葡萄糖生理鹽水效果較好，無刺激性，可以長期使用。
■此外，可以進行鼻腔沖洗，每天一次。
■為保護鼻黏膜，氣候乾燥時，出門時應戴口罩。
(三) 每天做鼻部摩擦或按摩鼻穴：用拇指沿鼻樑上下摩擦鼻翼數次，用食指旋轉按摩「迎香」穴數次，加強鼻部血液流通。
(四)內服維生素C，對毛細血管壁有保護作用，每日3次。
(五) 內服維生素A，有助於上皮的恢復，劑量為5000U，每日1次。
(七) 內服維生素B2，能促進細胞的正常新陳代謝，用量為10mg，每日3次。
(八) 內服魚肝油丸，2丸，每日3次。
七、消除秋燥引起的「火大」
「哈啾！哈啾！」，過敏的鼻子總是最先感受到秋天捎來的訊息。
有的人則會覺得口乾舌燥、喉嚨脹痛，很難受，猛灌水也沒用。
這些症狀是秋燥引起的，秋天氣候乾爽，燥氣導致身體缺水而上火，產生發炎、乾燥等不適。
中醫認為秋氣與人體的肺臟相通，若燥氣太強，容易引起上呼吸道疾病，如乾咳、喉嚨痛等，加上肺在五行中屬金，金剋木，肺氣強會傷屬木的肝，進而產生肝火、虛火，因此容易失眠、便秘或腹瀉。
此外肺也主皮毛，表現在皮膚上就是乾燥、緊繃、起疹子、泛紅。
（一）多吃「保濕」食物
1、解決身體「火大」引起的症狀，首要多吃滋陰潤燥的食物，增加體內的「保濕液」。有生津退火功效的杏仁、百合、銀耳、梨子、山藥、蘿蔔、豆腐是不錯選擇。
2、反之涼寒的食物要忌口，例如西瓜、香瓜等瓜果類，因為秋天漸漸陰長陽消，「秋瓜壞肚」，易損脾胃陽氣，造成腹瀉。
3、也要少吃辛辣食物，如蔥、薑、蒜、韭、椒等，以免加重乾燥症狀。
4、有些中藥則可以養滋潤肺，如西洋參、麥門冬、枸杞、茯苓、川貝母、玉竹等。一種避免「火大」的秘方是提氣的黃耆2錢、滋陰的麥冬3錢，再加補脾胃的沙蔘3錢，以500cc水煮沸後早晚飲用。
（二）體質虛寒的人，更應提早吃「溫熱」食補
而體質虛寒的人，更應提早養生，預防秋天寒氣入侵。尤其是「冷底」的過敏體質（深受氣喘、過敏性鼻炎、異位性皮膚炎所苦），為了避免過敏疾病發作，可從七夕（國曆八月）就開始就吃溫熱食物麻油雞，而且以人參、西洋參調氣，讓身體活絡，抵禦寒氣。
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