胸痛的原因有哪些

1、胸壁病變

胸壁變所引起的(de)(de)胸(xiong)痛(tong)是(shi)各類(lei)胸(xiong)痛(tong)中(zhong)最常見(jian)的(de)(de)一種，如胸(xiong)壁的(de)(de)外(wai)傷，細菌感染，病(bing)毒(du)感染，腫(zhong)瘤等引起的(de)(de)局(ju)部皮膚，肌(ji)肉，骨骼及神(shen)經(jing)病(bing)變。常見(jian)的(de)(de)急(ji)性皮炎(yan)(yan)，皮下蜂窩組炎(yan)(yan)，帶狀皰疹，痛(tong)性肥(fei)胖癥，肌(ji)炎(yan)(yan)及皮肌(ji)炎(yan)(yan)，流行性肌(ji)痛(tong)，頸椎(zhui)痛(tong)，肋(lei)軟(ruan)骨炎(yan)(yan)，骨腫(zhong)瘤，肋(lei)間(jian)神(shen)經(jing)炎(yan)(yan)，神(shen)經(jing)根痛(tong)等。其中(zhong)共同(tong)特征：

①疼痛(tong)的部(bu)位固定于病變處，且局(ju)部(bu)有明顯壓(ya)痛(tong)。

②深呼吸、咳嗽(sou)、舉(ju)臂(bei)、彎腰等(deng)動(dong)作(zuo)使胸廓活(huo)動(dong)疼(teng)痛加(jia)劇。

2、肺及胸膜病變

肺(fei)(fei)和臟(zang)(zang)層胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜對疼痛(tong)(tong)覺(jue)不敏感，肺(fei)(fei)炎(yan)(yan)，肺(fei)(fei)結(jie)核，肺(fei)(fei)膿腫，肺(fei)(fei)梗(geng)死等(deng)，由(you)于(yu)(yu)病(bing)變累及(ji)壁(bi)層而發(fa)(fa)(fa)生胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。肺(fei)(fei)癌(ai)侵及(ji)支氣(qi)管壁(bi)及(ji)壁(bi)層胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜都可產生胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。自(zi)發(fa)(fa)(fa)性氣(qi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)時由(you)于(yu)(yu)粘連撕(si)裂產生突然劇(ju)痛(tong)(tong)。干性胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜炎(yan)(yan)由(you)于(yu)(yu)炎(yan)(yan)癥波及(ji)臟(zang)(zang)層和壁(bi)層胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜發(fa)(fa)(fa)生摩擦而致胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。大量(liang)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔積認(ren)與張力性氣(qi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)可由(you)于(yu)(yu)壁(bi)層胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜受(shou)壓發(fa)(fa)(fa)生胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。其共同特點為：

①多(duo)伴咳嗽或咳痰(tan)。

②常因咳嗽、深呼(hu)吸(xi)而胸痛加重，其他胸壁活動并不引起疼痛。

③胸壁局部(bu)無壓痛。常伴(ban)有原發疾病(bing)之癥征，X線檢查可(ke)發現病(bing)變。

3、心血管系統疾病

常見原因心(xin)(xin)絞痛(tong)(tong)，心(xin)(xin)肌(ji)梗死及(ji)心(xin)(xin)包(bao)炎(yan)。心(xin)(xin)絞痛(tong)(tong)，心(xin)(xin)肌(ji)梗死，主動(dong)脈(mo)瓣疾病(bing)及(ji)心(xin)(xin)肌(ji)病(bing)引胸痛(tong)(tong)是(shi)由(you)(you)于(yu)心(xin)(xin)肌(ji)缺血所致。心(xin)(xin)包(bao)炎(yan)是(shi)由(you)(you)于(yu)病(bing)變累(lei)及(ji)第(di)5肋水(shui)平以下的心(xin)(xin)包(bao)壁(bi)層和鄰近胸膜而出現疼痛(tong)(tong)，其共(gong)同特征為：

①疼痛多(duo)位于胸骨后或心(xin)前區，少數在劍突下，可向左肩放射。

②疼痛(tong)常因體力活動誘發加重，休(xiu)息后好轉(zhuan)。

4、縱隔及食管病變

較少見，常(chang)見原(yuan)因有急(ji)(ji)性縱(zong)事炎(yan)，縱(zong)隔腫瘤，縱(zong)隔氣腫，急(ji)(ji)性食(shi)管(guan)(guan)炎(yan)，食(shi)管(guan)(guan)癌等。縱(zong)隔疾(ji)病(bing)是因縱(zong)隔內組織受壓，神經或骨質受累等因素引起胸痛(tong)。食(shi)管(guan)(guan)疾(ji)病(bing)主(zhu)要由于炎(yan)癥或化學刺激物作用于食(shi)管(guan)(guan)黏膜而引起。其共同(tong)特(te)征為：胸痛(tong)位于胸骨后，呈持續進(jin)行性隱痛(tong)或鉆痛(tong)，常(chang)放射(she)至其他(ta)部(bu)位。吞(tun)咽時(shi)疼痛(tong)加劇，伴有吞(tun)咽困難。

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為什么會產生胸痛

1、心絞痛不一定都是痛

典型的心(xin)絞痛是(shi)陣發(fa)性的前胸壓榨性疼痛，常常發(fa)生在勞動或(huo)情緒激動時，通常持(chi)續數分(fen)鐘，在休息(xi)或(huo)用硝酸甘油后消失。

但(dan)是，心絞痛也可(ke)以僅(jin)表現為胸悶(men)、窒息(xi)感、燒灼痛、重物壓(ya)胸感，并且(qie)癥狀(zhuang)逐漸加重，幾(ji)分鐘(zhong)內可(ke)放射至左肩、頸(jing)部、腹部，就(jiu)是心絞痛發(fa)生的嚴重警告信號了。

2、胸痛不一定都發生在胸骨后

典型的心絞痛主要疼(teng)痛(tong)部位是胸骨后，可放射至心(xin)前(qian)區(qu)和左上(shang)肢(zhi)，所以很多人描述疼(teng)痛(tong)部位為心(xin)前(qian)區(qu)一個手掌大的區(qu)域(yu)疼(teng)痛(tong)。

但是，部(bu)分人表(biao)現為咽喉痛(tong)(tong)(tong)(tong)、左(zuo)肩或雙肩痛(tong)(tong)(tong)(tong)、頸部(bu)痛(tong)(tong)(tong)(tong)和上(shang)中(zhong)腹(fu)痛(tong)(tong)(tong)(tong)。也(ye)可能沒有痛(tong)(tong)(tong)(tong)，僅感到胸悶、氣短、疲(pi)倦，而老年(nian)糖(tang)尿病(bing)患(huan)者也(ye)很少感到胸痛(tong)(tong)(tong)(tong)。所以，心(xin)絞(jiao)痛(tong)(tong)(tong)(tong)時(shi)的疼痛(tong)(tong)(tong)(tong)很難(nan)定位(wei)，若能準確地指(zhi)出疼痛(tong)(tong)(tong)(tong)點(dian)，或者胸壁有按壓痛(tong)(tong)(tong)(tong)，就(jiu)不太(tai)像心(xin)絞(jiao)痛(tong)(tong)(tong)(tong)了。

3、情緒或活動誘發胸痛

勞(lao)累、興奮(fen)、發怒、激動(dong)、受寒等，都可能誘發心絞(jiao)痛，特別是飯后、氣(qi)(qi)候寒冷或在(zai)冬天刮北風(feng)的(de)天氣(qi)(qi)仍在(zai)外(wai)面活(huo)動(dong)，更(geng)容易使胸痛發作。這也是心絞(jiao)痛的(de)重要特征之一。

需(xu)要(yao)注意的是(shi)，如(ru)果在(zai)活動(dong)的過程中出現胸(xiong)痛(tong)(tong)，更有可能是(shi)心絞痛(tong)(tong)，如(ru)果是(shi)活動(dong)、勞累了(le)一天以(yi)后，回到(dao)家里感(gan)覺(jue)胸(xiong)悶，心絞痛(tong)(tong)的可能性下降。

4、胸痛持續時間

一般典型的心(xin)絞痛發作，常(chang)常(chang)為3-5分鐘(zhong)，通過休息或含(han)服(fu)硝(xiao)酸甘油(you)可以(yi)緩(huan)解(jie)。如(ru)果劇烈胸痛持(chi)續時(shi)間在半個小時(shi)以(yi)上(shang)不(bu)能(neng)緩(huan)解(jie)，可能(neng)是發生了心(xin)肌梗死或主動脈夾層，兩種(zhong)疾病(bing)都是致命性的，需要立即搶救。

如果胸痛時間(jian)(jian)只有數(shu)秒(miao)即逝，往往提示肋間(jian)(jian)神經痛。胸痛了數(shu)天或(huo)數(shu)月(yue)而沒有其他(ta)表現(xian)，也不太可能是心絞痛。

5、“竹竿形”年輕人要警惕氣胸

之前有(you)(you)一(yi)個周末(mo)連續送來4個胸(xiong)痛年輕(qing)人，X線檢(jian)查發現都(dou)是“氣胸(xiong)”，其中有(you)(you)兩個還(huan)合并(bing)血胸(xiong)。這種自發性氣胸(xiong)多見于瘦高個的青壯年，典型表現為突發胸(xiong)痛，伴(ban)有(you)(you)胸(xiong)悶、憋氣、咳(ke)嗽，有(you)(you)時會有(you)(you)氣短(duan)、窒息感、煩躁不安、紫(zi)紺、出汗、休克等。如果(guo)氣胸(xiong)二次(ci)發作，必(bi)須手術治療。