5岁及以上儿童首次喘息发作病例临床特征分析

The clinical characteristics of first wheezing among children aged 5 years and over

目的探讨年长儿童首次喘息发作的临床特征,为临床医师早期确诊哮喘并尽早给予规范化治疗提供参照。方法收集2017年9月至2018年1月于首都儿科研究所附属儿童医院哮喘门诊5岁及以上首次喘息急性发作的患儿11例,男9例,女2例;年龄5～13岁。分析其临床特征、肺功能改变、致敏情况及发作诱因等。结果所有患儿均表现为咳嗽,5例伴喘息,5例伴憋气,2例伴胸闷。11例肺部闻及不同程度的哮鸣音,其中2例以湿啰音为主,1例呼吸音减低。肺功能检测均提示阻塞性通气功能障碍,以中重度为主。10例行支气管舒张试验,8例第一秒用力呼气量(forced expiratory volume in one second, FEV_1)改善>12%。过敏原检测提示均存在尘螨致敏,9例霉菌致敏,且程度均在3级或+++以上。结论年长儿童首次喘息即可表现为急性发作且以中重度为主,临床症状为咳嗽伴不同程度喘息、憋气、胸闷,肺部听诊以哮鸣音为主,肺功能检测提示可逆性气流受限,均存在吸入性过敏原高度致敏,发病前有明确诱因,除外其他疾病引起的喘息,可诊断为哮喘急性发作。

Objective To explore the clinical characteristics of first wheezing among 5 years or older children, and provide reference for clinicians of early identification of asthma and standardized treatment. Methods The first episode acute wheezing children aged 5 years or older who visited asthma clinic at Children’s Hospital Affiliated to Capital Institute of Pediatrics from September 2017 to January 2018 were selected, and their clinical features, lung function, sensitization and triggers were analyzed. Results There were 11 cases enrolled, including 9 males and 2 females with the age of 5 to 13 years old. All 11 children presented with cough, 5 with wheezing, 5 with breathlessness, and 2 with chest tightness.Different degrees of wheeze were heard in 11 cases, of which 2 cases were mainly with rales and 1 case with hypopnea.Pulmonary function tests showed obstructive ventilatory dysfunction, mainly with the degree of moderate to severe. Ten patients did the brochodilation test, and 8 patients were positive. Allergen detection indicated that there was dust mite and moulds sensitization, and the degree was all above 3 or +++. Conclusions The first episode acute wheezing children of school and preschool can manifest moderate to severe. The clinical symptoms are cough with wheezing, breathlessness,chest tightness. Lung function tests suggest reversible air flow limitation. All children are with inhaled allergens and have obvious triggers. Except for other diseases, first wheezing can be diagnosed as asthma exacerbation.