摘要
目的分析婴幼儿反复或持续喘息的病因分布,并探讨病因诊断程序。方法对临床以持续喘息≥4周或反复喘息≥3次、年龄≤3岁的185例住院患儿进行病史询问和查体,并进行肺功能、X线胸片、胸部CT或气管三维重建、纤维支气管镜、24h食管pH值监测等检查,结合治疗效果,最后确定病因诊断。结果婴幼儿反复或持续喘息病因比例依次为:支气管哮喘123例次(62.12%),气管支气管软化症22例次(11.11%),气管支气管狭窄18例次(9.09%),吸入因素10例次(5.05%,其中异物5例、胃食管反流2例、腭裂2例、气管食管瘘1例),支气管肺发育不良5例次(2.53%),闭塞性毛细支气管炎4例次(2.02%),支气管淋巴结结核4例次(2.02%),先天性心脏病4例次(2.02%),其他病因7例次(3.54%)。单一病因171例(92.4%),复合病因14例(7.6%)。结论支气管哮喘是婴幼儿出现反复或持续喘息的首要病因,支气管淋巴结结核、闭塞性毛细支气管炎等与感染相关的喘息性疾病亦不容忽视,6个月以内婴儿最多见的病因为先天性气道发育异常;反复或持续喘息、对常规治疗无效或不敏感者,应作纤维支气管镜、胸部CT三维重建检查,以排除其他原因所致喘息;应根据病因分布和临床特征,制定婴幼儿反复或持续喘息病因诊断程序。
Objective To investigate the spectrum and frequency of causes of recurrent or persistent wheezing in infants, and to establish its diagnostic protocol. Methods A total of 185 hospitalized children under 3 years old were recruited, with at least 4 weeks of persistent wheezing or recurrent wheezing more than three times. The causes were investigated through history inquiring, physical examination, pulmonary function tests, chest radiograph, 3-dimensional computed tomography reconstruction of chest, flexible bronchoscopy, 24 h oesophageal pH monitoring. The final diagnosis was made based on clinical manifestation, examination findings and a positive response to therapy. Results The causes of recurrent or persistent wheezing of infants was determined, with a single cause affecting 171 patients （92.4%） , and multiple causes affecting 14 patients （7.6%）. The eight most important causes were bronchial asthma （n = 123, 62.12%）, tracheobronchomalacia （n = 22, 11.11%）, tracheobronchial stenosis （n = 18, 9.09%）, aspiration （n = 10, 5.05% , including 5 foreign bodies, 2 gastroesophageal reflux, 2 cleft palate, 1 traeheoesophageal fistula）, bronchopulmonary dysplasia （n = 5, 2.53%）, bronchiolitis obliterans （n = 4, 2.02%）, bronchial lymphoid tuberculosis （n = 4, 2.02% ） and congenital heart diseases （n = 4, 2.02% ）. Conclusions Bronchial asthma is the major cause of recurrent or persistent wheezing of infants, bronchial lymphoid tuberculosis, bronchiolitis obliterans and other infection related diseases are other important causes, and congenital malformation should be considered as the main cause of wheezing in infants younger than 6 months. To those patients with recurrent or persistent wheezing but don＇t respond to routine treatment, flexible bronchoscopy, 3-dimensional computed tomography reconstruction of chest should be taken to rule out other causes. A diagnostic protocol of recurrent or persistent wheezing of infants should be established according to the spectrum and frequency of causes and clinical manifestation.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2009年第5期449-454,共6页
Journal of Clinical Pediatrics
