纤维鼻咽喉镜检查在儿童慢性咳嗽的临床意义

Clinical implications of fiberoptic nasopharyngolaryngoscopy for chronic cough among children

目的探讨纤维鼻咽喉镜检查在儿童慢性咳嗽相关性疾病的诊断价值。方法对咳嗽时间1个月以上的104例7～14岁儿童作临床观察,其中有鼻部症状者34例和经以上检查病因不明者16例加鼻窦CT检查和纤维鼻咽喉镜检查。结果诊断单纯性鼻咽炎3例,鼻炎鼻咽炎5例,鼻窦炎鼻咽炎11例,鼻窦炎鼻咽炎合并咳嗽变异性哮喘(CVA)28例,CVA或哮喘24例,支原体肺炎14例,其他(支气管炎、肺炎及咽喉炎)16例,病因不明3例。慢性咳嗽儿童中45.2%(47/104)有慢性鼻窦炎和(或)鼻咽炎。纤维鼻咽喉镜检查50例中除3例正常外,鼻腔鼻咽部黏膜均有不同程度炎性水肿、息肉样改变或息肉增生、或有黏脓痰液。结论对儿童慢性咳嗽应注意鼻窦炎鼻咽炎的伴发。有鼻部症状者和病因不明者应进一步行纤维鼻咽喉镜检查和鼻窦CT检查。

Objective To evaluate the clinically diagnostic implications of fiberoptic nasopharyngolaryngoscopy for chronic cough-related lesions among children. Methods Included in this study were 50 children out of a group of cases, 104 in total and aged from 7 to 14 years, with a history of cough lasted more than one month. Among them, 34 cases with nasal symptoms and 16 cases without definite etiological diagnosis made through various routine examination were given further clinical investigation with CT scanning on paranasal sinuses and fiberoptic nasopharyngolaryngoscopy in order to confirm the chronic cough-related lesions with etiological association. Results In this group of cases with chronic cough, 3 were diagnosed with simple nasopharyngitis, 5 with rhinitis and nasopharyngitis, 11 with sinusitis and nasopharyngitis, 28 with sinusitis and nasopharyngitis complicated by cough-varying asthma （CVA）, 24with CVA or asthma, 14 with mycoplasmal pneumonia, 16 with other conditions like bronchitis, pneumonia or phryngolaryngitis, and 3 as one with uncertained etiology. 45.2% （47/104） of these cases were seen with chronic sinusitis and/or nasopharyngitis. Among the 50 cases received CT scanning on paranasal sinuses and fiberoptic nasopharyngolaryngoscopy further, all were determined with various degrees of inflammatory edema, polypoid lesions or polyps growing in the mucosa of nasal and/or nasopharyngeal cavities, or with mucopurulent secretion adhered to the mucosa here, other than 3 cases with healthy mucosa in nasal and nasopharyngeal cavities. Conclusions Sinusitis and nasopharyngitis may complicate chronic cough among children. Therefore, those cases with chronic cough accompanied by nasal sympotoms, or with their etiology uncertained, should be given CT scanning on sinuses and fiberoptic nasopharyngolaryngoscopy to exclude the presence of nasosinuous and/or nasopharyngeal lesions.