儿童吞气症20例的诊断与治疗

目的探讨吞气症的诊断和治疗。方法收集本院2005年7月-2009年3月收治的吞气症患儿20例。男12例,女8例;年龄2～13岁。通过询问病史、体格检查、实验室检查,排除器质性疾病。对其临床资料进行回顾性分析。结果吞气症患儿20例,均符合儿童功能性胃肠病罗马Ⅲ诊断标准。临床主诉为腹胀20例(100%),可以见不自主的吞气现象20例(100%),频繁嗳气、食欲不振各18例(各占90%),便秘12例(60%),有心理压力8例(40%),反复腹痛6例(30%),慢性腹泻、急性腹痛各2例(各占10%)。查体:腹部明显隆起,触诊腹部柔软,无压痛,无包块,叩诊可闻及鼓音,听诊肠鸣音活跃或亢进。影像学检查显示胃肠道有大量气体,无液平面。经血尿粪常规、大便培养、肠道病毒和血生化等检查,排除感染、电解质紊乱和外科疾病。14例(70%)患儿经心理疏导、饮食调节,适当的通便药、胃肠动力药和多种维生素治疗后痊愈。6例(30%)严重者经上述治疗无效,口服硅油类药物(二甲硅油和西甲硅油)治疗效果好。结论儿童吞气症为功能性疾病。部分患儿伴精神方面异常,无精神方面异常的患儿吞气症通常为自限性,吞气现象持续数周或数月,但也可能持续更长时间。硅油类药物可以减轻儿童吞气症的临床症状,缩短其病程。

Diagnosis and Treatment in 20 Children with Aerophagia

Objective To investigate the diagnosis and treatment of childhood aerophagia. Methods Twenty children with aerophagia,aged 2-13 years old,hospitalized in Nanjing Children′s Hospital Affiliated to Nanjing Medical University from Jul.2005 to Mar.2009 were selected.All the diagnosis were made according to the medical history,physical examination and laboratory tests,parenchymal diseases were excluded.The clinical data of them were reviewed. Results The diagnostic clinical profiles suggested by Rome Ⅲ criteria,all the 20 cases of aerophagia were diagnosed.Of the 20 patients,the chief complaints were abdominal distention in 20 cases(100%),visible or audible air swallowing in 20 cases(100%),repetitive belching in 18 cases(90%),reduced appetite in 18 cases(90%),constipation in 12 cases(60%),psychological stresses in 8 cases(40%),recurrent abdominal pain in 6 cases(30%),chronic diarrhea in 2 cases(10%) and acute abdominal pain in 2 cases(10%).Physical examination:obvious abdominal distention,soft abdomen,no tenderness or mess,percussion for the sound of drums,auscultation for active bowel sounds.X-ray showed excessive gastrointestinal gas,with no liquid plane.The infection disease,electrolytes disturbance and surgical diseases were excluded by normal blood,urine and stool test,stool cultivation,enterovirus and blood biochemistry detection.Fourteen cases(70%) were cured by psychological counseling management,diet modification,laxatives,propulsives and vitamins.Six several cases were also cured after silicone oils(dimethicone or simethicone) treatment. Conclusions Aerophagia is a kind of functional gastrointestinal disorders in children.Part cases of aerophagia are accompanied with psychiatric disorders,a self-limited course were common observed in the patients without psychiatric disorders.Silicone oils can help to alleviate the clinical symptoms and may shorten the duration of illness.