本文關鍵詞： 上氣道咳嗽綜合征 常見病因 鼻炎/鼻竇炎 腺樣體肥大 兒童　出處：《大連醫(yī)科大學》2013年碩士論文　論文類型：學位論文

【摘要】：目的：了解兒童上氣道咳嗽綜合征的常見病因分布，探討上氣道咳嗽綜合征不同年齡組病因分布狀況及臨床特點，為兒童上氣道咳嗽綜合征的診斷及鑒別診斷提供臨床依據。 方法：采取回顧性分析的方法，選擇2010年9月至2013年3月在大連市兒童醫(yī)院慢性咳嗽門診就診及呼吸病房住院的慢性咳嗽患兒，并對符合兒童上氣道咳嗽綜合征納入標準的55例患兒的臨床表現(xiàn)、CT特點、常見病因進行分析總結，并記錄登記于病例表中。 結果： 1.在上氣道咳嗽綜合征55例患兒中，男性多于女性，男性占65.5%，男女比例為1.9:1；學齡前組高于學齡組，學齡前組占65%。 2.在55例上氣道咳嗽綜合征患兒中，單一病因38例，二重病因14例，三重病因3例，合計75例次病因診斷明確。其常見病因構成比依次為鼻竇炎、鼻炎、腺樣體肥大、喉部疾病，各占45.3%、37.3%、16%、1.4%。學齡前組與學齡組兒童上氣道咳嗽綜合征的病因構成與總體病因構成趨勢一致。腺樣體肥大的發(fā)生率學齡前組高于學齡組；鼻炎、鼻竇炎的發(fā)生率學齡前組低于學齡組。 3.在55例上氣道咳嗽綜合征患兒中，臨床癥狀上，除100%出現(xiàn)咳嗽外，50.9%的患兒出現(xiàn)打噴嚏、鼻塞；臨床體征上，45.5%的患兒出現(xiàn)陽性體征，其中咽后壁膿性分泌物、鼻竇區(qū)壓痛、鵝卵石征，分別占37%、34%、29%。 4.在55例上氣道咳嗽綜合征中，接受鼻竇CT檢查并確診鼻竇炎的患兒有34例，其中上頜竇受累的有27例，篩竇受累的有2例，上頜竇合并篩竇受累的有1例，上頜竇合并篩竇、蝶竇受累的有4例，共計43例次。43例次鼻竇炎患兒中以上頜竇炎為主，占74.4%，篩竇炎、蝶竇炎較少。 5.在55例上氣道咳嗽綜合癥中，37例進行了肺功能檢查，59%的患兒肺功能檢查結果正常，，41%的患者肺通氣功能異常，依次為小氣道通氣功能障礙、混合性肺通氣功能障礙和阻塞性通氣功能減退，分別為40%、33%和27%。 結論： 1.兒童上氣道咳嗽綜合征以學齡前組為主，常見病因依次為鼻竇炎、鼻炎、腺樣體肥大、喉部疾病。腺樣體肥大的發(fā)生率學齡前組高于學齡組，鼻炎、鼻竇炎的發(fā)生率學齡前組低于學齡組。 2.兒童上氣道咳嗽綜合征除100%出現(xiàn)咳嗽外，一半患兒出現(xiàn)打噴嚏、鼻塞，約一半的患兒出現(xiàn)陽性體征，其中咽喉壁膿性分泌物、鼻竇區(qū)壓痛、鵝卵石征各占1/3。提示臨床上對伴有打噴嚏、鼻塞的慢性咳嗽患兒，應注意存在上氣道咳嗽綜合征的傾向；對查體出現(xiàn)咽后壁膿性分泌物、鼻竇區(qū)壓痛、鵝卵石征的慢性咳嗽患兒，應高度提示上氣道咳嗽綜合征的診斷。 3.在鼻竇炎引起的兒童上氣道咳嗽綜合癥中，近4/5的患兒是上頜竇炎。 4.兒童上氣道咳嗽綜合癥，2/5的患兒肺通氣功能異常，依次為小氣道通氣功能障礙、混合性通氣功能障礙和阻塞性通氣功能減退。
[Abstract]:Objective: to investigate the etiological distribution and clinical characteristics of upper airway cough syndrome in children in different age groups, so as to provide clinical basis for the diagnosis and differential diagnosis of upper airway cough syndrome in children. Methods: retrospective analysis was used to select children with chronic cough from September 2010 to March 2013 in the chronic cough outpatient clinic and respiratory ward of Dalian Children's Hospital. The CT features and common etiology of 55 children with upper airway cough syndrome were analyzed and summarized. Results:. 1. In 55 cases of upper airway cough syndrome, male was more than female, male accounted for 65.5%, the ratio of male to female was 1.9: 1, preschool group was higher than school group, preschool group was 65%. 2. In 55 cases of upper airway cough syndrome, 38 cases had single cause, 14 cases had double cause, 3 cases had triple cause, 75 cases had definite etiological diagnosis. The common etiological factors were sinusitis, rhinitis and adenoid hypertrophy. Laryngeal diseases accounted for 37.3% of larynx respectively. The etiological composition of upper airway cough syndrome in preschool group and school-age group was consistent with the overall etiological composition. The incidence of adenoid hypertrophy in preschool group was higher than that in preschool group; rhinitis. The incidence of sinusitis in preschool group was lower than that in school-age group. 3. In 55 children with upper airway cough syndrome, 50.9% of them had sneezing and nasal obstruction except 100% cough, 45.5% of them had positive signs, including suppurative secretion of posterior pharynx wall, tenderness of nasal sinus area, The cobblestone signs, respectively, account for 37. 4. Of 55 cases of upper airway cough syndrome, 34 cases were diagnosed by nasal sinus CT, including 27 cases of maxillary sinus, 2 cases of ethmoid sinus, 1 case of maxillary sinus with ethmoid sinus, and 1 case of maxillary sinus complicated with ethmoid sinus. There were 4 cases of sphenoid sinus involvement, 43 cases of sinusitis. Maxillary sinusitis accounted for 74.4%, ethmoid sinusitis and sphenoid sinusitis were less. 5. Of the 55 cases of upper airway cough syndrome, 37 cases were examined with pulmonary function test (59%). The results of pulmonary function examination were normal in 41% of the patients with abnormal pulmonary ventilation function, followed by small airway ventilation dysfunction. Mixed pulmonary ventilation dysfunction and obstructive ventilation dysfunction were 40% and 27%, respectively. Conclusion:. 1. The main causes of upper airway cough syndrome in children were sinusitis, rhinitis, adenoid hypertrophy and laryngeal diseases. The incidence of sinusitis in preschool group was lower than that in school-age group. 2. In addition to cough in 100%, half of children with upper airway cough had sneezing, nasal congestion, and half of them had positive signs, including suppurative secretion of throat wall, tenderness in nasal sinus area. The cobblestone sign accounts for 1 / 3 of each. It suggests that children with chronic cough with sneezing and nasal congestion should pay attention to the tendency of upper airway cough syndrome, and the presence of suppurative secretion in the posterior pharynx wall, tenderness in the nasal sinus area, The diagnosis of upper airway cough syndrome should be highly recommended in children with chronic cough with cobblestone sign. 3. Nearly 4/5 of children with upper airway cough caused by sinusitis are maxillary sinusitis. 4. Children with upper airway cough syndrome (2 / 5) had abnormal pulmonary ventilation function, followed by small airway ventilation dysfunction, mixed ventilation dysfunction and obstructive ventilation dysfunction.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R725.6

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