摘要
目的分析儿童慢性咳嗽的病因,以及儿童慢性咳嗽误诊的相关原因。方法选取2018年1月—2022年1月收治的曾误诊慢性咳嗽患儿53例,分析其病例资料。结果53例中男32例,女21例;年龄7~12岁;病程4~28个月;有过敏性鼻炎、鼻窦炎史15例,有家族哮喘史12例。53例以不同程度咳嗽为主诉就诊,夜间刺激性咳嗽31例,日间发作性咳嗽20例,日间及夜间均咳嗽2例;伴剑突下不适、胸骨后烧灼感、反酸、嗳气12例;有鼻后滴流感或日常有频繁清喉动作15例。误诊慢性支气管炎31例、慢性咽炎22例,予镇咳、化痰、抗感染等治疗,症状未见明显改善。后26例行肺功能、支气管激发试验及诱导痰检查确诊咳嗽变异性哮喘;15例鼻后滴流感或日常有频繁清喉动作,有过敏性鼻炎、鼻窦炎史,鼻咽镜见咽后壁有黏液附着,确诊上气道咳嗽综合征;12例咳嗽伴胸骨后烧灼感、反酸、嗳气,胃镜发现反流性食管炎表现,确诊胃食管反流性咳嗽。误诊时间3~20个月。53例确诊后予相应治疗预后良好。结论儿童慢性咳嗽的病因复杂,临床医师应熟知儿童慢性咳嗽的多系统表现、病因及诊断流程,注意详细询问病史及用药史,仔细查体,注意咳嗽的性质、咳嗽的昼夜规律、咳嗽诱发因素,认真病因诊断,及时行相关特异性检查,以及早明确诊断并治疗,改善患儿生活质量。
Objective To analyze the etiology of chronic cough in children and the causes of misdiagnosis of chronic cough in children.Methods A total of 53 children with misdiagnosed chronic cough admitted from January 2018 to January 2022 were selected,and the case data were analyzed.Results Of the 53 patients,32 were males and 21 were females.They were aged 7-12 years,and the course of disease was 4-28 months.There were 15 patients with allergic rhinitis and sinusitis,and 12 patients with family history of asthma.All 53 patients presented with different degrees of cough as the main complaint,including 31 patients with night irritant cough,20 patients with daytime episodic cough,and 2 patients with both daytime and night cough.There were 12 patients with discomfort under xiphoid process,burning sensation behind sternum,acid reflux and belching,and 15 patients with postnasal drip or frequent throat clearing.There was misdiagnosis of chronic bronchitis in 31 patients and chronic pharyngitis in 22 patients.Treatment was given including cough relief,phlegm reduction,and anti-infection treatment,but the symptoms did not improve significantly.In 26 patients,cough variant asthma was confirmed by pulmonary function examination,bronchial stimulation test and induced sputum examination.Fifteen patients had postnasal drip or frequent throat clearing in daily life,and had a history of allergic rhinitis and sinusitis.After nasopharyngoscopy,mucus attached to the posterior pharyngeal wall was found,which was confirmed as upper airway cough syndrome.In 12 patients with cough accompanied by burning sensation,acid reflux,and belching,reflux esophagitis was found by gastroscopy and gastroesophageal reflux cough was confirmed.Misdiagnosis lasted 3 to 20 months.After diagnosis,53 cases were treated correspondingly with good prognosis.Conclusion The etiology of chronic cough in children is complex.Clinicians should be familiar with the multi-system manifestations,etiology and diagnostic procedures of chronic cough in children,conduct detailed
作者
田君平
张钰
申永旺
陈欣
TIAN Junping;ZHANG Yu;SHEN Yongwang;CHEN Xin(Department of General Pediatrics,the People's Hospital of Dingzhou City,Dingzhou,Hebei 073000,China)
出处
《临床误诊误治》
CAS
2024年第7期21-24,共4页
Clinical Misdiagnosis & Mistherapy
基金
河北省2019年度医学科学研究课题(20191752)。
关键词
慢性咳嗽
儿童
胃食管反流性咳嗽
误诊
慢性支气管炎
慢性咽炎
病因
鉴别诊断
Chronic cough
Children
Gastroesophageal reflux cough
Misdiagnosis
Chronic bronchitis
Chronic pharyngitis
Etiology
Differential diagnosis
