儿童难治性咳嗽128例病因分析

目的 探讨128例儿童难治性咳嗽的病因以及鼻部症状干预对儿童难治性咳嗽症状的影响.方法 128例在哮喘科诊断为难治性咳嗽的儿童来耳鼻咽喉科会诊,对通过电子鼻咽镜等检查确诊有鼻部疾病的患儿进行对症治疗.结果 128例患儿中,116例有鼻部症状,其中诊断为上气道咳嗽综合征(upper airway cough syndrome,UACS)者92例(71.9%),有鼻部疾病但未诊断为UACS者24例(18.7%),无鼻部疾病者12例(9.4%).在诊断为UACS患儿中,合并变应性鼻炎76例、鼻-鼻窦炎39例、腺样体肥大54例、慢性鼻炎8例.有鼻部疾病但未诊断为UACS的患儿中,慢性鼻炎10例,变应性鼻炎14例.诊断为UACS的92例患儿中有规律咳嗽的62例,有鼻部症状的65例,主观感觉鼻涕倒流的18例,口呼吸或打鼾的32例,鼻道内可见脓性分泌物的61例,咽后壁淋巴滤泡增生的58例,从口咽部可见鼻咽部脓性分泌物的41例,第1次电子鼻咽镜检查鼻咽部可见脓性或黏性分泌物者91例.经对症治疗14 d后,诊断为UACS的患儿的咳嗽缓解率为97.8%(90/92)高于无UACS的鼻部疾病患儿(13/24),差异有统计学意义(χ~2=32.21,P=0.000).结论 UACS在儿童难治性咳嗽患儿中有较高的发病比例,治疗鼻部疾病能有效缓解患儿咳嗽症状.

Analysis of intractable cough in 128 children

Objective To disclose the etiological factors and to investigate the therapeutical effect on nasal disorders in 128 children with intractable cough. Methods One hundred and twenty-eight children with intractable cough were consulted by ENT doctors using electronic nasopharyngoscope, for those children with nasal diseases, relevant treatment was given. Results Among 128 children, one hundred and sixteen had nasal disorders. Upper airway cough syndrome (UACS) was diagnosed in 92 cases(71.9% ), nasal disorders without UACS was diagnosed in 24 cases(18.7%) ,no nasal disorders were found in 12 cases (9.4% ). Among children with UACS, allergic rhinitis was diagnosed in 76 cases, rhino-sinusitis in 39 cases,adenoid hypertrophy in 54 cases, and chronic rhinitis in 8 cases. However, for those children without UACS, 10 cases had chronic rhinitis and 14 cases had allergic rhinitis. Clinical symptoms, signs and the findings of electronic nasopharyngescope were analyzed in 92 children with UACS. The results showed that regular cough occurred in 62 cases, nasal disease in 65 cases, subjective feeling of postnasal discharge in 18 cases, mouse breathing or snoring in 32 cases, purulent secretion in nasal meatus in 61 cases,retropharyngeal folliculosis in 58 cases, purulent secretion in pharynges detected from pharynx in 41 cases,and purulent or viscosity secretion were found in 91 cases by first electronic nasopharyngoscopy. After 14 days of treatment, the children with UACS (90/92) had significant higher remission rate (χ~2=32.21 ,P=0.000) in cough than those who had nasal disorders but without UACS (13/24). Conclusions The nasal disorders, especially for UACS, were common in children with intractable cough. The therapy to nasal disorders could release the chronic cough symptoms in children with intractable cough.