提高儿童慢性咳嗽的诊治水平

Improving diagnosis and treatment level of childhood chronic cough

儿童慢性咳嗽的病原、咳嗽反射、呼吸控制等与成人不同,套用成人慢性咳嗽指南不适于儿童。咳嗽持续时间超过8周定为慢性。以干咳和咳痰两种不同咳嗽进行区分,对诊断有所裨益。干咳常见于哮喘、咳嗽变异性哮喘、百日咳、上呼吸道感染等疾病后,这些患儿胸片多为阴性,肺功能和支气管舒张试验有助诊断。咳伴痰多为呼吸道感染疾病,胸片多见异常,必要时可做胸部CT、纤维支气管镜检以助诊断。小儿慢性咳嗽明确并去除病因即可治愈。

The etiology, respiratory reflex and respiratory control of chronic cough in children are different from those in adults. Guidelines for diagnosis and treatment of adults with chronic cough are not suitable for children. Cough lasting for more than eight weeks is defined as chronic cough. Dividing cough into unproductive （dry） and productive （wet） cough is of some benefits to diagnosis. Dry cough is commonly seen in asthma, cough variant asthma, pertussis, post upper respiratory infection, etc. Chest X-ray findings are usually negative in these diseases. Pulmonary function and bronchictasis test may help the diagnosis. Productive cough is mostly seen in airway infections with abnormal manifestations revealed on chest X-ray films. If necessary, chest CT or flexible bronchascopy may be used as the diagnostic procedure. Disclosure and removal of pathogenic factor may help cure chronic cough.