【作者】 马瑜聪；

【导师】 成焕吉；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 本文旨在观察吉林省儿童慢性咳嗽的病因构成及分析不同年龄组儿童慢性咳嗽的常见病因。选取83例于我科明确诊断为慢性咳嗽的患儿(均来自吉林省)。所有患儿均满足以下条件:年龄≤14岁,肺部无阳性体征,咳嗽时间大于4周,胸片无异常。采用《儿童慢性咳嗽诊断与治疗指南(试行)》并结合患儿的实际情况进行初步病因诊断,提供治疗方案。分别在完成治疗后半个月、1个月及3个月进行门诊或电话随访,根据治疗反应确定慢性咳嗽的病因。若治疗无效时选择相关辅助检查进一步明确病因。83例患儿中有80例完成随访,其中79例(79/80,98.8%)病因明确,1例(1/80,1.3%)病因未明。病因明确者中单一病因76例(76/79,96.2%),二重病因3例(3/79,3.8%)。包括二重病因在内,共计83例次慢性咳嗽病因。前4位病因依次为咳嗽变异性哮喘,呼吸道感染及感染后咳嗽,上气道咳嗽综合征及过敏性咳嗽。在婴幼儿组,呼吸道感染及感染后咳嗽居慢性咳嗽病因的首位;在学龄前和学龄期儿童组,咳嗽变异性哮喘居病因首位。因此吉林省儿童慢性咳嗽是由多病因引起的,其中主要有咳嗽变异性哮喘,呼吸道感染及感染后咳嗽,上气道咳嗽综合征及过敏性咳嗽,且不同年龄阶段病因分布有一定特征性。更多还原

【Abstract】 Background: Cough is an important defense mechanism that helps clear the respiratory secretions and harmful factors from the airways, whether in adults or children, are the most common respiratory out-patient clinical symptoms. And to cough as the sole or main symptoms of chronic cough and continued refractory often doctors lack of knowledge of treatment difficult.The past 20 years, many European and American countries and the domestic are the causes of adult cough and its treatment in various aspects of the system and to develop guidelines on diagnosis and treatment of cough. However, research in the field of children with chronic cough, the domestic late start, much less documented. Because children are not miniature adults, and its anatomical, physiological and immunological aspects are some differences between adults, so apply theory and experience in adults with chronic cough to analysis and diagnosis of the cause of chronic cough in children, and sometimes can not get the expected results and child growth and development of different ages there own characteristics.Therefore, all age groups are common causes of chronic cough there are differences.Chronic cough is defined as the only or main symptom of patients, X-ray examination of chest showed normal but cough of unknown reasons, the domestic current diagnosis of chronic cough in children, the duration of cough was considered more than 4 weeks. The etiology of chronic cough is variable,and more than one pathogenic factor occurs in one patient. However, children with chronic cough on the lack of domestic multi-center, large sample, prospective study of epidemiological survey data.This study is one of the single center in "Chinese children with chronic cough in multi-center study constitutes" ,which is on going.Objective:To detect and classify the pathogenic factors of chronic cough in children in Jilin province; Observation and analysis of different age groups of children are common causes of chronic cough.Methods: A total of 83 patients referred to in this dissertation were those who went to the pediatric respiratory medicine clinic of the First Hospital of Jilin University, for their coughs from May 2009 to January 2010, of which were all from Jilin Province territory. All children aged≤14 years, no signs of the lungs, cough time was more than four weeks, the chest radiograph was normal. Use of "Diagnosis and treatment of children with chronic cough Guide (trial)" made the diagnosis process, and make the appropriate adjustments, concrete steps are as follows:①detailed history, including cough nature, when the phase, duration, related factors, accompanying symptoms, the initial onset cases (with or without foreign body aspiration, cough history, etc.), past medical history (especially rhinitis, asthma history, immune status), growth and development history, family history, allergies, history of exposure to infectious diseases (especially whooping cough and TB), the recent examination and treatment and so on.②line comprehensive physical examination, not only for the respiratory system.Taking care of other systems, if necessary, the related specialist visits.③According to the medical history, physical examination, conventional X-ray, blood routine, serum IgM antibody against Mycoplasma pneumoniae; other examinations will be selected, including pulmonary function, allergy testing, PPD skin test, lung CT, Electronics nasopharyngeal endoscopy, esophageal barium meal, etc., necessary for fiberoptic bronchoscopy examination or diagnostic treatment.④According to the information available to make a preliminary diagnosis of the cause and provide treatment.⑤After completion of treatment were two weeks, 1 month and 3 months, 3 times out / telephone follow-up, and ultimately determine the treatment response according to the cause of chronic cough, ineffective treatment and then select the additional tests.The disease specific diagnostic criteria and treatment options related to the literature and see the combination of line-related adjustment in children with specific conditions.Results: 83 patients were followed up during the case off in 3 cases. Children with complete follow-up of 80 cases diagnosed in 79 cases (98.8%), unknown etiology in 1 case (1.2%). Confirmed by the single cause of 76 cases (96.2%), duplex causes in 3 cases (3.8%). Including duplex causes included, a total of 83 cases of chronic cough. The four important causes were cough variant asthma (45.8%), respiratory infections and postinfectious cough (41.0%), upper airway cough syndrome (6%), atopic cough (of 2.4%). In infants and toddlers group, respiratory infections and postinfectious cough did cough of chronic data for the first; in preschool and school-age children, the first cause of chronic cough is cough variant asthma. The three cases of chronic disease in duplex cases, two of the children were both have the Upper airway cough syndrome and cough variant asthma, one has the Upper airway cough syndrome and bronchiectasis. Three months after the visit, the patient cough all last a long time, provided treatment, two of the cases the cough symptoms of clinical control, one of the cough of the previous alleviate the symptoms. There is a chronic cough was not clear the diagnosis .Conclusion:1. Children with chronic cough complex, Jilin Province, the region is mainly the cause of chronic cough cough variant asthma, respiratory infections and postinfectious cough, upper airway cough syndrome, and allergic cough;2. A "diagnosis of children with chronic cough and treatment guidelines (Trial) "proposed diagnostic procedure to diagnose the vast majority of chronic cough in children; Treatment for the cause of the child will relieve the symptoms.3. Children with chronic cough etiology in different age groups have a certain characteristic distribution: In infants and toddlers group, respiratory infections and postinfectious cough did cough of chronic data for the first; in preschool and school-age children, the first cause of chronic cough is cough variant asthma.更多还原