396例儿童难治性咳嗽病因探讨

Study on etiology in 396 children cases of intractable cough

目的探讨儿童难治性咳嗽的病因,为临床诊治提供依据。方法回顾性分析该院2013年2月至2016年7月收治的396例难治性咳嗽患儿临床资料,对其临床症状、合并症及电子鼻咽喉镜检查结果进行总结,分析难治性咳嗽形成原因及治疗效果。结果根据是否合并鼻部疾病进行区分,396例患儿中42例(10.61%)未合并鼻部疾病,其余354例(89.39%)患儿均合并鼻部疾病。在合并鼻部疾病的354例患儿中,285例(80.51%)确诊为上呼吸道咳嗽综合征,69例(19.49%)仅单纯合并鼻部疾病。分析285例确诊为上呼吸道咳嗽综合征患儿的临床症状,出现鼻塞、流涕、鼻痒等鼻部症状201例,规律咳嗽189例,自感鼻涕倒流63例,口咽部可见鼻咽部脓性分泌物129例,首次电子鼻咽喉镜检查可见鼻咽部脓性或黏性分泌物267例,咽喉壁淋巴滤泡增生162例,鼻道内脓性分泌物174例,打鼾或经口呼吸87例。入组的354例合并鼻部疾病的患儿均在该院耳鼻咽喉科进行治疗,咳嗽症状均在14d内明显缓解。其中合并上呼吸道咳嗽综合征患儿治疗7、14d咳嗽缓解率均高于单纯合并鼻部疾病患儿,差异有统计学意义(P<0.05)。结论儿童难治性咳嗽中合并鼻部疾病及上呼吸道咳嗽综合征的比例较高,给予针对性治疗后患儿咳嗽症状可有效缓解。

Objective To investigate the etiology of child intractable cough to provide a basis for its clinical treatment.Methods The clinical data in 396 children patients with intractable cough in the hospital from February 2013 to July 2016 were retrospectively analyzed.Their clinical symptoms,complications and electronic nasopharyngolaryngoscopic examination results were summarized.The formation causes and treatment effect of intractable cough were analyzed.Results Among 396 children cases according to whether complicating nasal diseases,42cases（10.61%）had no complicating nasal disease and other 354cases（89.39%）were combined with nasal diseases.In 354 cases of complicating nasal diseases,285cases（80.51%）were diagnosed as upper airway cough syndrome,69cases（19.49%）were simple complicating nasal disease.The clinical symptoms in 285 cases of upper airway cough syndrome were analyzed,201 cases had the nasal symptoms of stuffy nose,runny nose,nasal itching,189 cases had regular cough,63 cases had self inductance of postnasal drip,129 cases had oropharynx visible nasopharynx purulent secretion,267 cases had purulent or sticky secretion in nasopharynx by the first time electronic nasopharyngolaryngoscopy,162 cases had lymphoid follicles hyperplasia in the wall of pharynx,174 cases had purulent secretion in nasal meatus and 87 cases had snoring or mouth breathing.354 cases of complicating nasal diseases were treated in the otolaryngology department of our hospital,the cough symptom was significantly relieved within 14 d,in which the cough relief rates within 7,14 din the cases of complicating upper airway cough syndrome were higher than those in the cases of simple complicating nasal diseases,the difference was statistically significant（P〈0.05）.Conclusion The proportion of complicating nasal disease and upper airway cough syndrome in children patients with intractable cough is higher,and giving targeted therapy can effectively alleviate the cough symptom.