92例儿童鼻后滴漏综合征诊治分析.docVIP

92例儿童鼻后滴漏综合征诊治分析 92例儿童鼻后滴漏综合征诊治分析 青岛海慈王静 目的　探讨儿童鼻后滴漏综合征(PNDS)致慢性咳嗽的临床特点和治疗方法。方法　92例患儿临床确诊为鼻后滴漏综合征后采用抗炎、抗变态反应、局部使用减充血剂、糖皮质激素等系统治疗。结果　92例患儿均随诊2个月以上,以主观症状是否改善作为评价指标,其中80例患儿咳嗽症状消失, 12例咳嗽症状明显减轻。结论　尽管儿童鼻后滴漏综合征病因复杂,但咳嗽是PNDS的主要临床特点,通过系统的治疗,可取得较理想的效果。青岛海慈医院中医儿科王静 　　关键词　儿童鼻后滴漏综合征；慢性咳嗽；系统治疗 Analysis of 92 postnasal drip syndrome in children of ambulatory treatment WangJing （(Department of Paediatrics, Haici Hospital, Qingdao Medical College, Qingdao University, Qingdao, 266033 ) 【Abstract】　Objective　To discuss the clinical features and the treatment for the chronic cough caused by postnasal drip syndrome in children. Method　92 children who were diagnosed with postnasal drip syndrome were given Comprehensive treatment program of combinding with antiinflammatory, anti-allergy, topical application of decongestant and glucocoriticoid. The evaluation index is subjective symptom improvement. Result　The follow-up of the 92 patients was at least for two months. Cough disappeared in 80 patients, and cough symptom improvement occurred in 12 patients. Conclusion　Although the cause of postnasal drip syndrome in children is complicated, cough is an important clinical feature. Comprehensive treatment program can achieve the desired effect . 【Key words】　postnasal drip syndrome; chronic cough; comprehensive treatment 　　　小儿咳嗽是儿科门诊常见病症之一,也是许多家长烦恼之事。特别是小儿慢性咳嗽,咳嗽久治不愈,家长往往辗转多家医院,这其中原因是慢性咳嗽病因诊断不明。鼻后滴漏综合征(PNDs)与哮喘、胃食管反流性疾病共同构成了小儿慢性咳嗽的3大主因,占小儿慢性咳嗽的85%~98% ,其中PNDs发病率为28.0%~57.6%,引起从事儿科及耳鼻咽喉头颈外科医师的广泛注意。由于PNDS易被医生忽视,从而延误治疗。本文回顾性分析2006年1月~2008年12月在我院中医儿科门诊治疗,并随访2月以上的92例PNDS患儿的临床资料,现报告如下。 1 资料与方法 1.1　一般资料　本组92例中,男57例,女35例；年龄2~14岁,平均6.5岁。92例均以咳嗽为主要症状,咳嗽时间1~6个月, 7例仅表现为咳嗽,伴鼻塞、流涕42例,夜眠张口呼吸和(或)打鼾28例,咽部异物感、咽部不适25例,头痛12例,嗅觉功能下降7例,耳鸣3例。68例查体见咽后壁黏性或黏脓性分泌物附着和(或)咽后壁结节状淋巴滤泡增生。92例均行血常规检查,中性粒细胞升高30例,白细胞升高22例。92例均行胸部X线检查,其中68例未见异常, 31例呈支气管炎影像, 5例呈支气管肺炎影像。70例行鼻窦CT检查示:窦腔黏膜肥厚超过6 mm,有液平面,窦腔密度升高39例,息肉影5例, 26例未见异常。 本组49例初诊时误诊,误诊率53.4%,误诊为咽炎及扁桃体炎19例,支气管炎16例,咳嗽变异型哮喘8例,支气管肺炎4例,支气管异物、肺结核各1例。 1.2 诊断标准　依据中华医学会推荐的诊断标准[1]