儿童上气道咳嗽综合征的临床研究

发布时间：2018-02-16 04:04

本文关键词： 上气道咳嗽综合征常见病因鼻炎/鼻窦炎腺样体肥大儿童　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：了解儿童上气道咳嗽综合征的常见病因分布，探讨上气道咳嗽综合征不同年龄组病因分布状况及临床特点，为儿童上气道咳嗽综合征的诊断及鉴别诊断提供临床依据。方法：采取回顾性分析的方法，选择2010年9月至2013年3月在大连市儿童医院慢性咳嗽门诊就诊及呼吸病房住院的慢性咳嗽患儿，并对符合儿童上气道咳嗽综合征纳入标准的55例患儿的临床表现、CT特点、常见病因进行分析总结，并记录登记于病例表中。结果： 1.在上气道咳嗽综合征55例患儿中，男性多于女性，男性占65.5%，男女比例为1.9:1；学龄前组高于学龄组，学龄前组占65%。 2.在55例上气道咳嗽综合征患儿中，单一病因38例，二重病因14例，三重病因3例，合计75例次病因诊断明确。其常见病因构成比依次为鼻窦炎、鼻炎、腺样体肥大、喉部疾病，各占45.3%、37.3%、16%、1.4%。学龄前组与学龄组儿童上气道咳嗽综合征的病因构成与总体病因构成趋势一致。腺样体肥大的发生率学龄前组高于学龄组；鼻炎、鼻窦炎的发生率学龄前组低于学龄组。 3.在55例上气道咳嗽综合征患儿中，临床症状上，除100%出现咳嗽外，50.9%的患儿出现打喷嚏、鼻塞；临床体征上，45.5%的患儿出现阳性体征，其中咽后壁脓性分泌物、鼻窦区压痛、鹅卵石征，分别占37%、34%、29%。 4.在55例上气道咳嗽综合征中，接受鼻窦CT检查并确诊鼻窦炎的患儿有34例，其中上颌窦受累的有27例，筛窦受累的有2例，上颌窦合并筛窦受累的有1例，上颌窦合并筛窦、蝶窦受累的有4例，共计43例次。43例次鼻窦炎患儿中以上颌窦炎为主，占74.4%，筛窦炎、蝶窦炎较少。 5.在55例上气道咳嗽综合症中，37例进行了肺功能检查，59%的患儿肺功能检查结果正常，，41%的患者肺通气功能异常，依次为小气道通气功能障碍、混合性肺通气功能障碍和阻塞性通气功能减退，分别为40%、33%和27%。结论： 1.儿童上气道咳嗽综合征以学龄前组为主，常见病因依次为鼻窦炎、鼻炎、腺样体肥大、喉部疾病。腺样体肥大的发生率学龄前组高于学龄组，鼻炎、鼻窦炎的发生率学龄前组低于学龄组。 2.儿童上气道咳嗽综合征除100%出现咳嗽外，一半患儿出现打喷嚏、鼻塞，约一半的患儿出现阳性体征，其中咽喉壁脓性分泌物、鼻窦区压痛、鹅卵石征各占1/3。提示临床上对伴有打喷嚏、鼻塞的慢性咳嗽患儿，应注意存在上气道咳嗽综合征的倾向；对查体出现咽后壁脓性分泌物、鼻窦区压痛、鹅卵石征的慢性咳嗽患儿，应高度提示上气道咳嗽综合征的诊断。 3.在鼻窦炎引起的儿童上气道咳嗽综合症中，近4/5的患儿是上颌窦炎。 4.儿童上气道咳嗽综合症，2/5的患儿肺通气功能异常，依次为小气道通气功能障碍、混合性通气功能障碍和阻塞性通气功能减退。
[Abstract]:Objective: to investigate the etiological distribution and clinical characteristics of upper airway cough syndrome in children in different age groups, so as to provide clinical basis for the diagnosis and differential diagnosis of upper airway cough syndrome in children. Methods: retrospective analysis was used to select children with chronic cough from September 2010 to March 2013 in the chronic cough outpatient clinic and respiratory ward of Dalian Children's Hospital. The CT features and common etiology of 55 children with upper airway cough syndrome were analyzed and summarized. Results:. 1. In 55 cases of upper airway cough syndrome, male was more than female, male accounted for 65.5%, the ratio of male to female was 1.9: 1, preschool group was higher than school group, preschool group was 65%. 2. In 55 cases of upper airway cough syndrome, 38 cases had single cause, 14 cases had double cause, 3 cases had triple cause, 75 cases had definite etiological diagnosis. The common etiological factors were sinusitis, rhinitis and adenoid hypertrophy. Laryngeal diseases accounted for 37.3% of larynx respectively. The etiological composition of upper airway cough syndrome in preschool group and school-age group was consistent with the overall etiological composition. The incidence of adenoid hypertrophy in preschool group was higher than that in preschool group; rhinitis. The incidence of sinusitis in preschool group was lower than that in school-age group. 3. In 55 children with upper airway cough syndrome, 50.9% of them had sneezing and nasal obstruction except 100% cough, 45.5% of them had positive signs, including suppurative secretion of posterior pharynx wall, tenderness of nasal sinus area, The cobblestone signs, respectively, account for 37. 4. Of 55 cases of upper airway cough syndrome, 34 cases were diagnosed by nasal sinus CT, including 27 cases of maxillary sinus, 2 cases of ethmoid sinus, 1 case of maxillary sinus with ethmoid sinus, and 1 case of maxillary sinus complicated with ethmoid sinus. There were 4 cases of sphenoid sinus involvement, 43 cases of sinusitis. Maxillary sinusitis accounted for 74.4%, ethmoid sinusitis and sphenoid sinusitis were less. 5. Of the 55 cases of upper airway cough syndrome, 37 cases were examined with pulmonary function test (59%). The results of pulmonary function examination were normal in 41% of the patients with abnormal pulmonary ventilation function, followed by small airway ventilation dysfunction. Mixed pulmonary ventilation dysfunction and obstructive ventilation dysfunction were 40% and 27%, respectively. Conclusion:. 1. The main causes of upper airway cough syndrome in children were sinusitis, rhinitis, adenoid hypertrophy and laryngeal diseases. The incidence of sinusitis in preschool group was lower than that in school-age group. 2. In addition to cough in 100%, half of children with upper airway cough had sneezing, nasal congestion, and half of them had positive signs, including suppurative secretion of throat wall, tenderness in nasal sinus area. The cobblestone sign accounts for 1 / 3 of each. It suggests that children with chronic cough with sneezing and nasal congestion should pay attention to the tendency of upper airway cough syndrome, and the presence of suppurative secretion in the posterior pharynx wall, tenderness in the nasal sinus area, The diagnosis of upper airway cough syndrome should be highly recommended in children with chronic cough with cobblestone sign. 3. Nearly 4/5 of children with upper airway cough caused by sinusitis are maxillary sinusitis. 4. Children with upper airway cough syndrome (2 / 5) had abnormal pulmonary ventilation function, followed by small airway ventilation dysfunction, mixed ventilation dysfunction and obstructive ventilation dysfunction.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.6

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