儿童鼻后滴漏综合征诊治分析

Diagnosis and synthetic treatment of postnasal drip syndrome among children

目的探讨儿童鼻后滴漏综合征致慢性咳嗽的临床特点和治疗方法。方法 90例患儿,通过症状、体征分析及相关检查而确诊病因,分别予以抗炎、抗变态反应及局部治疗,部分患儿并行鼻内镜手术。结果 90例患儿中确诊为变应性鼻炎44例(49%),变应性鼻炎合并鼻窦炎混合感染6例(7%),慢性鼻窦炎30例(33%),慢性鼻炎4例(4%),腺样体肥大4例(4%),腺样体肥大合并鼻窦炎2例(2%)。所有患儿均以咳嗽为主诉,仅6例年长患儿表述自觉鼻后滴漏感;所有患儿咽后壁可见黏性或脓性分泌物。疗后随诊6个月以上,76例患儿咳嗽症状消失,咽后壁未见明显分泌物;14例咳嗽症状明显减轻,咽后壁黏性分泌物减少。结论儿童鼻后滴漏综合征病因复杂,多以慢性咳嗽为主要临床特点,病因治疗可获较理想疗效。

Objective To sum up clinical features of chronic cough caused by postnasal drip syndrome among children and to explore an effective synthetic therapy for such a lesion. Methods Included in this study were 90 children diagnosed as postnasal drip syndrome through a systematic analysis on their symptoms, signs and associated special examination, such as nasal endoscopy, fiberopic laryngoscopy, paranasal sinus CT scanning, responsible allergen determination and other necessary diagnostic measures to determine its etiologically possible causes. Then, all these cases were treated according to the principle of causative treatment for different case, such as anti-inflammation therapy, anti-allergic therapy, use of glucocorticoids and/or decongestant given in a local way etc., with part of them undergone nasal endoscopic surgery. Results The causes identified responsible for the diagnosis of these children included allergic rhinitis in 44 cases （49%）, allergic rhinitis complicated with sinusitis in 6 cases （7%）, chronic sinusitis in 30 cases （33%）, chronic rhinitis in 4 cases （4%）, adenoid vegetation in 4 cases （4%）, and adenoid vegetation complicated with sinusitis in 2 cases （2%）. All of them were seen with a chief complaint of cough, but only 6 elder children could clearly express their feeling of postnasal drip by themselves. Viscous, or purulent, secretion could be seen adhered to posterior pharyngeal wall among all these cases. By the end of following up period lasted for more than 6 months after the therapy finished, the chief symptom of cough disappeared in 76 cases, with no secretion seen at the posterior pharyngeal wall any more under direct vision, and the other 14 children showed their main symptom of cough improved obviously, with secretion adhered to the posterior pharyngeal wall reduced notably. Conclusion The causes responsible for postnasal drip syndrome in children are very complicated, but chronic cough is the most important clinical feature for such a lesion. Etilogical treatment should be effective for this condition.