鼻后滴漏综合征致儿童慢性咳嗽238例

目的探讨鼻后滴漏综合征(PNDs)致儿童慢性咳嗽的因素及诊断与治疗方法。方法回顾性分析以慢性咳嗽为主要表现并确诊为PNDs的238例患儿,采用抗炎、抗变应反应、解除鼻腔阻塞、通畅鼻窦引流及减低咳嗽反射等治疗方法。疗程结束后,以患儿主诉及相应检查进行评定,以主观症状是否改善为评价指标,综合分析患儿的临床特点及治疗反应,并随访3个月。结果本组1个月治愈者135例(56.8%);2个月治愈者176例(73.9%);3个月治愈者220例(92.4%)。18例(7.6%)症状改善不明显。结论对表现为慢性咳嗽的PNDs患儿,应积极综合治疗鼻后滴漏,可有效消除继发性咳嗽。     

以慢性咳嗽表现的多发性抽动症31例

目的探讨儿童慢性咳嗽与多发性抽动症的关系,提高多发性抽动症的诊断准确率。方法回顾性分析31例以慢性咳嗽为主要表现的多发性抽动症患儿发病情况﹑临床特点﹑诊治结果及随访情况。结果多发性抽动症患儿31例中表现为清嗓14例(45.1%),干咳9例(29.0%),吸鼻5例(16.1%),犬吠样咳嗽3例(9.6%);患儿初期均按呼吸道感染治疗。12例(38.7%)误诊为鼻后滴漏综合征,13例(41.9%)误诊为咳嗽变异型哮喘,4例(13.5%)误诊为变应性咳嗽,2例(6.5%)误诊为胃食管反流。结论发声性抽动是儿童多发性抽动症引起慢性咳嗽常见原因,对常规治疗效果差的慢性咳嗽患儿注意排除多发性抽动症。     

鼻后滴流综合征致儿童慢性咳嗽68例临床分析

目的 探讨儿童鼻后滴流综合征（postnasal drip syndrome,PNDS）致慢性咳嗽的临床特点和治疗方案。方法 对68例临床确诊为PNDS的患儿,根据临床表现、辅助检查、治疗等作回顾性分析。结果 68例中慢性鼻窦炎32例（47．1％）,慢性鼻炎20例（29．4％）,变应性鼻炎13例（19．1％）,急性腺样体炎3例（4．4％）,均以慢性咳嗽为主诉。经过积极的抗炎与抗变态反应治疗以及必要的手术治疗,60例（88．2％）咳嗽症状消失,8例（11．8％）症状明显减轻。结论 PNDS以咳嗽为主要临床特点,而不表现出典型的鼻一鼻窦疾病症状,是儿童慢性咳嗽较常见的原因。积极治疗鼻一鼻窦疾病,可有效地消除慢性咳嗽。     

慢性咳嗽60例病因及诊断分析

目的分析慢性咳嗽的病因，探讨慢性咳嗽的诊断程序。方法本院儿童反复呼吸道感染门诊就诊的慢性咳嗽患儿72例患儿中，慢性孤立性咳嗽60例，根据其咳嗽特征、辅助检查、治疗反映等确定慢性咳嗽的病因。结果慢性孤立性咳嗽60例中，鼻后滴漏综合征40例，其中副鼻窦炎26例（并腺样体肥大4例）、过敏性鼻炎14例；咳嗽变异性哮喘16例；原发性胃食管反流3例；原因不明1例。结论鼻后滴漏综合征、咳嗽变异性哮喘、原发性胃食管反流是儿童慢性咳嗽主要原因。根据咳嗽的特征、辅助检查、治疗反映等能确定绝大部分慢性咳嗽的病因。     

儿童鼻源性疾病就诊原因分析

目的 分析鼻源性疾病就诊原因和临床特点.方法 对2005年4月-2006年5月3588例鼻源性疾病的门诊病例进行回顾性分析,对其就诊原因、临床表现及与诊断间的相互联系进行探讨.结果 诊断为鼻源性疾病的3588例患儿中,以鼻部症状为主诉就诊的为2090例(58.24%),主要包括鼻塞、流鼻涕、鼻出血及鼻痛;以非鼻部症状就诊的为1498例(41.76%),主要就诊原因依次为:睡眠呼吸暂停及打鼾(470例)、耳痛及耳漏(332例)、慢性咳嗽(145例)、头痛和头晕(138例)、咽部症状(133例)、反复下呼吸道感染(92例).结论 以非鼻部原因就诊,最终诊断为鼻源性疾病的患儿所占比例近半,对于一些儿内科等科室临床治疗效果不理想的患儿应警惕鼻源性疾病.     

鼻后滴漏综合征致儿童慢性咳嗽55例临床分析

目的总结鼻后滴漏综合征(postnasal drip syndrome,PNDS)引起儿童慢性咳嗽的临床特点,提高对PNDS引起儿童慢性咳嗽的认识。方法回顾性分析2005年10月至2006年11月,在深圳市妇幼保健院儿科门诊就诊的PNDS引起慢性咳嗽的55例患儿的诊治过程及转归情况,总结诊治经验。结果55例患儿均以慢性咳嗽为主诉,病程超过4周,X线胸片检查无异常。确诊PNDS后,经相关治疗,症状明显消失或减轻。结论PNDS是引起儿童慢性咳嗽的主要原因之一,因病因多且与临床症状的关系复杂而易被误诊、漏诊并导致误治。当慢性咳嗽久治不愈且易反复时,应考虑此病的可能性,并给予针对性治疗。     

儿童慢性咳嗽52例病因诊断分析

目的 探计儿童慢性咳嗽病因及其分类方法.方法 对2006年1月至2008年3月新乡医学院第二附属医院及新乡市第二人民医院收治的52例慢性咳嗽患儿的临床特点进行回顾,分析引起慢性咳嗽的病因疾病,并时诊断程序进行总结.结果 52例患儿病因疾病分别为呼吸道感染与感染后咳嗽16例(30.8%)、上气道咳嗽综合征(UACS)14例(26.9%)、咳嗽变异性哮喘(CVA)10例(19.2%)、特异性咳嗽4例(7.7%)、胃食管反流性咳嗽(CERC)2例(3.8%)、嗜酸粒细胞性支气管炎(EB)2例(3.8%)、心因性2例(3.8%)、先天性呼吸道疾病1例(1.9%)和其他1例(1.9%).其中呼吸道感染与感染后咳嗽、UACS、CVA为引起儿童慢性咳嗽的主要病因.结论 应强调对慢性咳嗽病因疾病的诊断及治疗,程序式诊断对儿童慢性咳嗽病因疾病的诊断具有较强的可操作性.     

儿童慢性咳嗽的病因分析及进展

慢性咳嗽是儿童的常见症状,目前对其定义不一,有趋势以咳嗽为主要或惟一症状、胸部X线检查无明显异常和咳嗽持续时间≥18周定为慢性咳嗽.过去认为鼻后滴漏综合征、咳嗽变异型哮喘、胃食管反流为慢性咳嗽的三大病凶,现在发现嗜酸细胞性支气管炎、过敏性咳嗽、反复呼吸道感染、病毒感染后咳嗽等亦是重要原因.不同年龄慢性咳嗽的病因分布和临床特点各有不同,加强对病因的认识有助于慢性咳嗽的诊治.     

临床特征对儿童慢性咳嗽常见病因诊断的价值

目的 对慢性咳嗽常见病因的临床特征进行研究,分析其对各病因诊断的价值.方法 选取2008年1月 - 2009年12月门诊就诊的慢性咳嗽初诊患儿496例,按慢性咳嗽诊断程序作出慢性咳嗽初步诊断并按时随访,根据随访患儿治疗效果得出最终诊断.结果 496例患儿中感染后咳嗽(PIC)69例,咳嗽变异性哮喘(CVA)和变应性咳嗽(AC)219例,上气道咳嗽综合征(UACS)139例.CVA的临床特征主要为夜间咳嗽、干性咳嗽、特应性体质;UACS的临床特征主要为湿痰咳嗽、晨起咳嗽.结论 儿童慢性咳嗽主要病因为CVA、UACS、AC和PIC.各种病因的慢性咳嗽具有其主要的临床特征,其病因构成及临床特征可为经验性诊治慢性咳嗽提供参考.     

儿童慢性咳嗽与嗜肺军团菌感染的关系探讨

目的 探讨儿童慢性咳嗽与嗜肺军团菌(LP)感染的关系.方法 对确诊的66例以慢性咳嗽为主要表现的LP感染患儿临床特点进行分析.结果 66例确诊病例中,男31例,女35例;年龄8个月～15岁,其中以3～5岁最多,占39.4%(26/66).临床表现以咳嗽为主要症状或唯一症状,48%(32/66)的病例无肺部体征.82%(54/66)的病例外周血白细胞在(4～10)×10/L之间,常规C反应蛋白(CRP)＜10 mg/L者占64%(42/66),胸片表现可有多种形式.结论 LP感染可能是小儿慢性咳嗽的病因之一,临床在诊治儿童慢性咳嗽时应有相应对策.     

Chronic/recurrent cough in rural children in Ludhiana, Punjab.

OBJECTIVE: To determine the prevalence, age distribution and common causes of chronic/recurrent cough in rural children. DESIGN: Prospective study. SETTING: Pediatric population in five villages of Dehlon Block of Ludhiana, Punjab. METHODS: 2275 children in the age group of 1 to 15 years were screened by house to house survey for chronic/recurrent cough using defined criteria. A detailed work up of selected cases was carried out. Underlying etiology was determined using clinical and laboratory parameters. Five hundred children in the study population formed the control group. Variables associated with chronic/recurrent cough were analyzed in cases and controls. RESULTS: Twenty four children were diagnosed with chronic/recurrent cough showing a prevalence rate of 1.06 percent. The most common cause was bronchial asthma (66.7 percent) followed by postnasal drip syndrome (25 percent). Family history of allergy/asthma was noted in 11 (45.8 percent) children as compared to 52 (10.4 percent) in the control group (p < 0.01). Family history of smoking was recorded in 16.7 percent of cases in contrast to 6.4 percent in controls (p = 0.05). There was no significant association with overcrowding, pets and kind of cooking fuel used. CONCLUSIONS: The most common cause of chronic/recurrent cough was bronchial asthma. There was a significant association with family history of allergy/asthma and smoking.     

儿童慢性咳嗽的程序式诊断方法探讨

目的 分析儿童慢性咳嗽的病因分布,并对儿童慢性咳嗽的程序式诊断方法进行探讨。方法 参考Morice的慢性咳嗽诊断程序,对81例慢性咳嗽儿童进行逐步评估。最后的诊断结果分为明确诊断、疑似诊断和病因未明。结果 明确诊断65例（80．3％）,疑似诊断15例（18．5％）,病因未明1例。81例慢性咳嗽中前几位病因依次为气管、支气管异物（16．9％）,咳嗽变异型哮喘／哮喘（15．7％）,肺部感染（后）（14．5％）,鼻后滴注综合征（8．4％）,先天气管、支气管狭窄或其他发育异常（7．2％）。不同的年龄阶段病因分布有一定特征性。结论 儿童慢性咳嗽的病因复杂,应用程序式诊断方法可明确大部分病因,其病因分布具有年龄特点;病史、体检、影像学检查及肺功能测定在儿童慢性咳嗽的病因诊断中发挥重要作用;诊断过程应予动态评价,及时随访。最后对Morice诊断程序作出补充。     

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目的探讨慢性孤立性咳嗽的病因诊断及其程序。方法从首都医科大学附属北京儿童医院2003年10月至2004年8月在门诊就诊的58例慢性咳嗽患儿中,首先筛选慢性孤立性咳嗽病例,进一步根据咳嗽特征、辅助检查、治疗反应等确定慢性孤立性咳嗽的病因。结果在58例慢性咳嗽的患儿中,筛选出慢性孤立性咳嗽50例,其中鼻后滴流综合征20例(8例慢性副鼻窦炎,6例慢性过敏性鼻炎,6例感染后鼻炎)、咳嗽变异性哮喘17例、感染后咳嗽5例、心理性咳嗽4例、原发性胃食道反流1例、嗜酸粒细胞性支气管炎2例、未明原因1例。结论儿童慢性孤立性咳嗽的病因有鼻后滴流综合征、咳嗽变异性哮喘、感染后咳嗽、心理性咳嗽等。根据咳嗽特征、辅助检查、治疗反应等能确定绝大多数慢性孤立性咳嗽的病因。     

小儿慢性咳嗽诊断与鉴别诊断

慢性咳嗽是指咳嗽症状至少持续3周,以咳嗽为主要表现,胸部X线检查无明显病变。通过临床表现和相关检查可对慢性咳嗽进行诊断和鉴别诊断。引起小儿慢性咳嗽的三大病因是咳嗽变异性哮喘(CVA)、鼻窦炎及鼻后滴流综合征(PNDs)和胃食管反流(GER)性疾病,而在小儿还须注意呼吸道感染因素和先天性肺发育畸形。近年来国内外研究表明,嗜酸细胞性支气管炎(EB)亦是慢性咳嗽的重要原因。此外,还应注意支气管扩张、支气管异物、药物性咳嗽及精神性咳嗽。     

Acute and chronic cough

Cough is a normal protective mechanism which occurs many times every day. Cough with a viral infection lasts up to 2 weeks in 70-80% of children. Cough present for more than 4 weeks may be due to a recognized specific cause or non specific and considered protracted bronchitis. Chronic cough in children is different to that in adults and rarely due to GE reflux, postnasal drip or asthma. Treatment addresses the specific cause and symptomatic treatment is rarely needed or effective.     

福建省福州地区儿童慢性咳嗽病因分析

目的 探讨福建省福州地区儿童慢性咳嗽的病因.方法 根据中华医学会儿科学分会呼吸学组与<中华儿科杂志>编辑委员会2008年制定的<儿童慢性咳嗽诊断与治疗指南>的标准,对福建省福州儿童医院哮喘专科门诊诊断的364例慢性咳嗽患儿,按照指南的诊断流程询问病史,进行体检、辅助检查,初步确定病因后,并针对病因进行特异性治疗,分别在初诊后半个月、1个月、3个月对患儿进行随访,根据辅助检查及疗效判定病因诊断,进而分析病因构成比.结果 364例慢性咳嗽患儿病因依次为:咳嗽变异性哮喘171例(47.0%),上气道咳嗽综合征104例(28.6%),呼吸道感染和感染后咳嗽58例(15.9%),胃食管反流17例(4.7%),支气管异物3例(0.8%);引起慢性咳嗽只有单一病因的299例(82.1%),同时有2种病因的56例(15.4%),同时有3种病因的9例(2.5%).结论 福建省福州地区儿童慢性咳嗽的病因依次为咳嗽变异性哮喘、上气道咳嗽综合征、呼吸道感染和感染后咳嗽、胃食管反流、支气管异物;不同年龄组儿童慢性咳嗽病因构成比不同;部分患儿合并有2或3种病因,表明儿童慢性咳嗽病因呈多因素.

Abstract：

Objective Chronic cough in children is a common pediatric symptom with complex causes and its diagnosis is difficult; chronic cough affects the life of children in both physical and mental health and also learning. Therefore this study aimed to investigate the causes of chronic cough in children in Fuzhou area of Fujian province. Method Data were collected from 364 children with chronic cough who visited the asthma specialist clinic of Children's Hospital of Fuzhou, Fujian Province from March 2009 to April 2010. The diagnosis was made according to Guideline for Diagnosis and Treatment of Chronic Cough in Pediatrics published in 2008. Among the patients, 241 were boys and 123 girls. The patients were divided into 3 age groups: group 1, 1 to 3 years old ( infants and young children group, n =75); group 2, 4 to 6years old (pre-school group, n =215 ); and group 3, over 7 years (school-age group, n = 74), the mean age was (4.8 ± 1.1) years (3 months to 14 years), course of the illness was (4.5 ± 1.8) months (4 weeks to 38 months ). Mycoplasma pneumoniae was detected by Enzyme-linked immunosorbent assay (ELISA). Result The causes of chronic cough were as follows: 171 cases (46. 98% ) had cough variant asthma; 104 cases ( 28.57% ) had upper airway cough syndrome; 58 cases ( 15.93% ) had respiratory infections; 17 cases (4.67% ) had gastroesophageal reflux; 3 cases (0.82% ) had foreign bodies. Totally 9 cases (2.47% ) had chronic cough associated with 3 causes; 56 cases ( 15.38% ) had 2 causes and 299cases ( 82.14% ) had single cause. The main causes of cough in the group of pre-school children were cough variant asthma and upper airway cough syndrome. The proportion of the upper airway cough syndrome in school-age children group was the highest among the 3 age groups, which is flowed by cough variant asthma.Conclusion The causes of chronic cough in children were cough variant asthma, upper airway cough syndrome, respiratory infections, cough after infection, gastroesophageal reflux and foreign bodies in Fuzhou area of Fujian province. Children with chronic cough in different age groups had different etiology, in about 18% of the children the etiology of chronic cough was associated with 3 or 2 causes, indicating that the causes of chronic cough in children are multifactorial.     

支气管舒张试验在小儿慢性咳嗽鉴别诊断中的应用

目的探讨支气管舒张试验在小儿慢性咳嗽鉴别诊断中的应用价值。方法对以干咳为主的263例慢性咳嗽患儿进行肺功能检测,其中气道阻力增高者加做支气管舒张试验,改善率>20%为阳性。结果115例支气管舒张试验中阳性共71例,支气管舒张前后呼吸阻抗各值比较差异有统计学意义。结论支气管舒张试验阳性有助于咳嗽变异型哮喘(CVA)诊断,在小儿慢性咳嗽鉴别诊断中有一定应用价值。     

儿童慢性湿性咳嗽病因构成比多中心研究

目的　了解中国儿童慢性湿性咳嗽的病因构成比,为儿童慢性湿性咳嗽的正确诊治提供指导。方法　2015年6月至2018年5月在全国17个省、自治区、直辖市共26所医院进行前瞻性儿童慢性湿性咳嗽的病因构成比研究, 通过中国儿童慢性湿性咳嗽的问卷调查及3个月的治疗随访, 了解我国儿童慢性湿性咳嗽的病因构成比。结果　实际入组病例数1505例,合格病例1470例,合格率97.67％。位于病因构成比前4位的分别是上气道咳嗽综合征584例（39.73%）、哮喘合并上气道咳嗽综合征241例（16.39%）、哮喘合并感染164例（11.16%）、迁延性细菌性支气管炎151例（10.27%）。1岁以下患儿的首位病因是迁延性细菌性支气管炎（40.00%）。多病因的慢性湿性咳嗽有效病例数483例, 占总病例数33.74%, 其主要病因是哮喘合并上气道咳嗽综合征, 占16.39%。华东、 北方、 南方3个地区首位病因均为上气道咳嗽综合征。其他病因在不同年龄的分布存在差异; 不同病因在不同地区的分布也存在差异; 同一种病因则呈现季节性变化。结论　中国儿童慢性湿性咳嗽的主要病因依次为上气道咳嗽综合征、 哮喘合并上气道咳嗽综合征、 哮喘合并感染、 迁延性细菌性支气管炎。1岁以下患儿首位病因是迁延性细菌性支气管炎。在不同年龄、 不同地区和不同季节, 儿童慢性湿性咳嗽病因构成比不尽相同。     

Ineffectiveness of oral terfenadine in natural colds: evidence against histamine as a mediator of common cold symptoms

The role of histamine in the pathogenesis of infectious rhinitis is unclear, as is the efficacy of antihistaminic drugs in the treatment of the common cold. This study evaluated the short-term efficacy of oral terfenadine (Seldane) in the treatment of the common cold. Over a 5-week period, the authors recruited 250 adults who had developed cold symptoms within 6 to 48 hours prior to enrollment. Volunteers had a primary complaint of runny or stuffy nose; at least one other respiratory symptom; no fever or exudative pharyngitis; and no history of atopy, sinusitis, or use of cold preparations within 1 week of enrollment. Out of the eligible subjects, 126 were randomly assigned terfenadine (60 mg), and 124 received placebo. Volunteers self-administered either terfenadine or placebo twice a day on Days 1, 2 and 3, and a final dose on the morning of Day 4. They also recorded the severity of their clinical symptoms (runny nose, sniffles, sneezing, postnasal drip, cough and sore throat) on symptom cards. Both groups reported similar severity scores throughout the treatment period. Average symptom burdens declined at almost identical rates for both groups. Terfenadine was well tolerated and had a low incidence of side effects. According to subject evaluation, terfenadine was no more effective than placebo. The mean +/- SD score of global efficacy was 2.2 +/- 1.1 in the terfenadine group and 2.1 +/- 1.3 in the placebo group (P = NS). Slightly fewer terfenadine recipients (41%) than placebo recipients (48%) said they would use the study medication again for treating cold symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Psychogenic cough: Another etiology for persistent cough

The most common causes of persistent cough are upper respiratory tract disease (postnasal drip syndrome, infections) and asthma. In the last year, six patients (four boys and two girls), aged 7-12 years old, with a diagnosis of hard-to-manage asthma and/or persistent cough were referred to our department. All the patients had undergone treatment with multiple drugs for long periods without favorable clinical response. The findings of physical examination, radiology, basal pulmonary function and post-bronchodilation and fibrobronchoscopy were normal. Organic disease was ruled out and a psychiatric evaluation was performed. Intelligence quotient was in the lower normal range and generalized anxiety order was identified, thus establishing a diagnosis of psychogenic cough. Treatment consisted of relaxation techniques and psychopedagogic support with favorable outcome. To avoid diagnostic errors and inappropriate treatment, psychogenic cough should be included in the differential diagnosis of persistent cough and hard-to-manage asthma.