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。

Evaluation of the diagnostic algorithm for chronic cough in children

Objectives To explore the spectrum and frequency of causes and the diagnostic protocol for chronic cough in children. Methods A total of 81 children with chronic cough in the outpatient and inpatient departments of our hospital from January 2004 to February 2006 were included. The causes were investigated by using a well- established algorithm by Morice and his colleagues. The evaluation was performed step by step and the final diagnostic results were classified into three categories: specific diagnosis,probable diagnosis and non- specific diagnosis. Results A specific diagnosis was made in 80.3 % of the cases. The five most important causes of cough in these children were:foreign body aspiration(16.9 %),asthma or cough- variant asthma(15.7 %),post- pulmonary infection(14.5 %),postnasal drip syndrome(8.4 %)and congenital anomalies(7.2 %). A modified diagnostic algorithm was established accordingly. Conclusions The causes of chronic cough in children were complex. Most causes could be identified by using the diagnostic algorithm. The distribution of causes of chronic cough has age related characteristics. Other factors,including medical history,physical examination,pulmonary function tests and X- ray examination,play important roles in the diagnosis of chronic cough in children. The process of diagnosis is dynamic and follow- up is necessary.