胸痛的原因有哪些

1、胸壁病變

胸壁變(bian)所(suo)引起的(de)胸(xiong)痛(tong)是(shi)各類胸(xiong)痛(tong)中(zhong)最常見的(de)一(yi)種，如胸(xiong)壁的(de)外傷，細菌感染，病毒感染，腫瘤等引起的(de)局部皮膚，肌肉(rou)，骨骼及神經病變(bian)。常見的(de)急性(xing)皮炎，皮下蜂窩組(zu)炎，帶狀皰疹，痛(tong)性(xing)肥胖癥，肌炎及皮肌炎，流行(xing)性(xing)肌痛(tong)，頸椎(zhui)痛(tong)，肋軟骨炎，骨腫瘤，肋間神經炎，神經根痛(tong)等。其中(zhong)共同(tong)特征：

①疼痛的部(bu)位固定于病變處，且局部(bu)有(you)明(ming)顯壓痛。

②深呼(hu)吸、咳嗽(sou)、舉臂、彎腰等動(dong)作(zuo)使胸廓活動(dong)疼痛加(jia)劇。

2、肺及胸膜病變

肺和臟層(ceng)(ceng)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)對(dui)疼痛(tong)(tong)覺不敏感，肺炎，肺結核，肺膿腫，肺梗死等(deng)，由(you)于病變累(lei)及(ji)壁(bi)層(ceng)(ceng)而發(fa)生胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。肺癌(ai)侵及(ji)支氣(qi)管壁(bi)及(ji)壁(bi)層(ceng)(ceng)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)都(dou)可產生胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。自(zi)發(fa)性氣(qi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)時由(you)于粘連撕裂產生突然劇痛(tong)(tong)。干(gan)性胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)炎由(you)于炎癥(zheng)波及(ji)臟層(ceng)(ceng)和壁(bi)層(ceng)(ceng)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)發(fa)生摩擦而致胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。大(da)量胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔積(ji)認與張力性氣(qi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)可由(you)于壁(bi)層(ceng)(ceng)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)受壓發(fa)生胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)。其共同(tong)特點為：

①多(duo)伴咳(ke)嗽或咳(ke)痰。

②常因(yin)咳嗽、深(shen)呼吸而胸(xiong)痛加重，其他胸(xiong)壁活動(dong)并不引起疼(teng)痛。

③胸壁局部無(wu)壓痛(tong)。常伴有(you)原發疾病之癥征，X線檢查(cha)可發現病變。

3、心血管系統疾病

常見原因(yin)心(xin)絞痛(tong)(tong)，心(xin)肌(ji)(ji)梗死及(ji)(ji)心(xin)包炎。心(xin)絞痛(tong)(tong)，心(xin)肌(ji)(ji)梗死，主(zhu)動脈(mo)瓣疾病(bing)及(ji)(ji)心(xin)肌(ji)(ji)病(bing)引胸(xiong)痛(tong)(tong)是由(you)于心(xin)肌(ji)(ji)缺血所致。心(xin)包炎是由(you)于病(bing)變累(lei)及(ji)(ji)第(di)5肋水平以(yi)下的心(xin)包壁層和(he)鄰近胸(xiong)膜而出現疼痛(tong)(tong)，其(qi)共(gong)同特征為：

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

②疼痛常因體(ti)力活動誘發加重，休(xiu)息后好(hao)轉。

4、縱隔及食管病變

較少(shao)見(jian)，常(chang)見(jian)原(yuan)因有(you)急性(xing)縱(zong)(zong)事(shi)炎，縱(zong)(zong)隔腫瘤，縱(zong)(zong)隔氣(qi)腫，急性(xing)食管炎，食管癌等。縱(zong)(zong)隔疾病是因縱(zong)(zong)隔內組織(zhi)受壓，神(shen)經(jing)或骨質受累(lei)等因素(su)引起胸痛(tong)。食管疾病主要由于(yu)炎癥或化學刺激(ji)物作(zuo)用(yong)于(yu)食管黏膜而引起。其共同特征為：胸痛(tong)位于(yu)胸骨后，呈(cheng)持(chi)續進行性(xing)隱痛(tong)或鉆痛(tong)，常(chang)放射至其他(ta)部位。吞咽時疼痛(tong)加劇，伴(ban)有(you)吞咽困難。

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為什么會產生胸痛

1、心絞痛不一定都是痛

典型的心絞痛是陣發(fa)性(xing)的前胸壓榨性(xing)疼痛，常(chang)常(chang)發(fa)生在(zai)勞動或情緒激動時(shi)，通常(chang)持續數(shu)分鐘，在(zai)休息或用(yong)硝酸甘油后(hou)消失(shi)。

但是(shi)，心(xin)絞痛也(ye)可以(yi)僅表現為胸悶、窒息感(gan)、燒(shao)灼(zhuo)痛、重物壓胸感(gan)，并且癥狀逐漸(jian)加重，幾分鐘(zhong)內可放(fang)射(she)至左肩、頸(jing)部、腹(fu)部，就是(shi)心(xin)絞痛發生(sheng)的嚴(yan)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痛(tong)(tong)部位(wei)(wei)是胸骨后，可(ke)放射至心前區和(he)左上(shang)肢，所以很多人描(miao)述(shu)疼痛(tong)(tong)部位(wei)(wei)為心前區一個手掌大(da)的區域疼痛(tong)(tong)。

但是，部分人表現為咽(yan)喉(hou)痛(tong)(tong)(tong)(tong)(tong)、左肩或(huo)雙(shuang)肩痛(tong)(tong)(tong)(tong)(tong)、頸部痛(tong)(tong)(tong)(tong)(tong)和上中腹(fu)痛(tong)(tong)(tong)(tong)(tong)。也可能沒有(you)痛(tong)(tong)(tong)(tong)(tong)，僅感到胸(xiong)悶(men)、氣短、疲倦，而老(lao)年糖尿(niao)病患者也很(hen)少感到胸(xiong)痛(tong)(tong)(tong)(tong)(tong)。所(suo)以，心(xin)絞痛(tong)(tong)(tong)(tong)(tong)時的疼(teng)痛(tong)(tong)(tong)(tong)(tong)很(hen)難(nan)定位，若能準確地指出疼(teng)痛(tong)(tong)(tong)(tong)(tong)點(dian)，或(huo)者胸(xiong)壁有(you)按壓痛(tong)(tong)(tong)(tong)(tong)，就不太像心(xin)絞痛(tong)(tong)(tong)(tong)(tong)了。

3、情緒或活動誘發胸痛

勞(lao)累、興奮、發怒(nu)、激動、受寒(han)等，都(dou)可能(neng)誘發心(xin)絞痛(tong)，特別是飯后、氣候寒(han)冷(leng)或在(zai)冬天(tian)刮(gua)北風的天(tian)氣仍在(zai)外面活動，更容易使胸痛(tong)發作。這也是心(xin)絞痛(tong)的重要特征之一。

需要注(zhu)意的(de)是，如果在活動(dong)的(de)過程(cheng)中(zhong)出現(xian)胸痛(tong)，更(geng)有可能是心絞痛(tong)，如果是活動(dong)、勞累(lei)了(le)一天以后，回到家(jia)里感覺胸悶，心絞痛(tong)的(de)可能性下降。

4、胸痛持續時間

一般(ban)典型的(de)心(xin)絞痛發作，常常為(wei)3-5分鐘，通過休息(xi)或(huo)含服(fu)硝酸甘油可以(yi)緩(huan)(huan)解(jie)。如(ru)果劇烈胸痛持(chi)續時間在半個小時以(yi)上不能緩(huan)(huan)解(jie)，可能是(shi)(shi)發生(sheng)了心(xin)肌梗死或(huo)主動(dong)脈夾層，兩種疾(ji)病都是(shi)(shi)致命性的(de)，需要(yao)立即搶(qiang)救。

如(ru)果(guo)胸痛(tong)時間只(zhi)有數(shu)秒即逝，往(wang)往(wang)提示肋間神經(jing)痛(tong)。胸痛(tong)了數(shu)天或數(shu)月而沒有其他表現，也(ye)不(bu)太可(ke)能(neng)是心(xin)絞痛(tong)。

5、“竹竿形”年輕人要警惕氣胸

之前有(you)一個周(zhou)末連(lian)續(xu)送(song)來4個胸痛(tong)(tong)年輕人，X線檢查發(fa)現都(dou)是(shi)“氣胸”，其中有(you)兩個還合(he)并血胸。這種自發(fa)性氣胸多見于瘦(shou)高個的青壯年，典型(xing)表現為突發(fa)胸痛(tong)(tong)，伴(ban)有(you)胸悶、憋氣、咳嗽(sou)，有(you)時會有(you)氣短、窒息感、煩躁(zao)不安、紫(zi)紺、出汗、休克等。如(ru)果氣胸二次發(fa)作(zuo)，必(bi)須手術治療。