儿童上气道咳嗽综合征的临床研究

中图分类号 密级儿童上气道咳嗽综合征的临床研究Clinical Research of Upper Airway CoughSyndrome in Children计：学位论文：30页表 格： 1个插 图： 7幅指导教师：崔振泽教授申请学位级别：硕士学位培养单位：大连医科大学大连市儿童医院乔在霞学科(专业)：儿科学完成时间：二O一三年五月答辩委员会主席：独创性声明本人声明所呈交的学位论文是本人在导师指导下进行的研究工作及取得的研究成果。据我所知，除了文中特别加以标注和致谢的地方外，论文中不包含其他人已经发表或撰写过的研究成果，也不包含为获得大连医科大学或其他教育机构的学位或证书而使用过的材料。与我一同工作的同志对本研究所做的任何贡献均已在论文中作了明确的说明并表示谢意。学位论文作者签名：签字日期：趁年兰月卫日关于学位论文使用授权的说明本学位论文作者完全了解学校有关保留、使用学位论文的规定，同意学校保留并向国家有关部门或机构送交论文的复印件和电子版，允许论文被查阅和借阅。本人授权大连医科大学可以将本学位论文的全部或部分内容编入有关数据库进行检索，可以采用影印、缩印或扫描等复制手段保存和汇编本学位论文。本学位论文属于(请在以下相应方框内打，v”)：1保密口，在一年解密后适用本授权书。2不保密瓯篡裔 日期：匕，年罗月了日日期：20f多年歹月7日35目 录一、摘要1(一)中文摘要1(二)英文摘要3二、正文5(一)前言5(一)日U舌5(二)材料和方法51纳入标准52排除标准53诊断标准64研究分组75研究方法76结果判定标准。87仪器98统计学处理9(三)结果91上气道咳嗽综合征患儿的年龄分布92上气道咳嗽综合征患儿的病因分布103上气道咳嗽综合征患儿的临床表现11(四)讨论13(五)结论1 6(六)参考文献1 7三、文献综述19(一)综述正文19(二)参考文献26四、附录m O Qi DI m QQ Bi D Dra m29五、致谢30大连医科大学硕士学位论文儿童上气道咳嗽综合征的临床研究硕士生姓名：乔在霞指导教师：崔振泽教授指导小组：黄燕教授专业名称：儿科学摘要目的：了解儿童上气道咳嗽综合征的常见病因分布，探讨上气道咳嗽综合征不同年龄组病因分布状况及临床特点，为儿童上气道咳嗽综合征的诊断及鉴别诊断提供临床依据。方法：采取回顾性分析的方法，选择2010年9月至2013年3月在大连市儿童医院慢性咳嗽门诊就诊及呼吸病房住院的慢性咳嗽患儿，并对符合儿童上气道咳嗽综合征纳入标准的55例患儿的临床表现、CT特点、常见病因进行分析总结，并记录登记于病例表中。结果：1在上气道咳嗽综合征55例患儿中，男性多于女性，男性占655，男女比例为19：1；学龄前组高于学龄组，学龄前组占65。2在55例上气道咳嗽综合征患几中，单一病因38例，二重病因14例，三重病因3例，合计75例次病因诊断明确。其常见病因构成比依次为鼻窦炎、鼻炎、腺样体肥大、喉部疾病，各占453、373、16、14。学龄前组与学龄组儿童上气道咳嗽综合征的病因构成与总体病因构成趋势一致。腺样体肥大的发生率学龄前组高于学龄组：鼻炎、鼻窦炎的发生率学龄前组低于学龄组。3在55例上气道咳嗽综合征患儿中，临床症状上，除100出现咳嗽外，509的患儿出现打喷嚏、鼻塞；临床体征上，455的患儿出现阳性体征，其中咽后壁脓性分泌物、鼻窦区压痛、鹅卵石征，分别占37、34、29。4在55例上气道咳嗽综合征中，接受鼻窦CT检查并确诊鼻窦炎的忠儿有34例，其中上颌窦受累的有27例，筛窦受累的有2例，上颌窦合并筛窦受累的有1例，上颌窦合并筛窦、蝶窦受累的有4例，共计43例次。43例次鼻窦炎患儿中以上颌窦炎为主，占744，筛窦炎、蝶窦炎较少。大连医科大学硕士学位论文5在55例上气道咳嗽综合症中，37例进行了肺功能检查，59的患儿肺功能检查结果正常，41的患者肺通气功能异常，依次为小气道通气功能障碍、混合性肺通气功能障碍和阻塞性通气功能减退，分别为40、33和27。结论：1儿童上气道咳嗽综合征以学龄前组为主，常见病因依次为鼻窦炎、鼻炎、腺样体肥大、喉部疾病。腺样体肥大的发生率学龄前组高于学龄组，鼻炎、鼻窦炎的发生率学龄前组低于学龄组。2儿童上气道咳嗽综合征除100出现咳嗽外，一半患儿出现打喷嚏、鼻塞，约一半的患儿出现阳性体征，其中咽喉壁脓性分泌物、鼻窦区压痛、鹅卵石征各占13。提示临床上对伴有打喷嚏、鼻塞的慢性咳嗽患儿，应注意存在上气道咳嗽综合征的倾向；对查体出现咽后壁脓性分泌物、鼻窦区压痛、鹅卵石征的慢性咳嗽患儿，应高度提示上气道咳嗽综合征的诊断。3在鼻窦炎引起的儿童上气道咳嗽综合症中，近45的患儿是上颌窦炎。4儿童上气道咳嗽综合症，25的患儿肺通气功能异常，依次为小气道通气功能障碍、混合性通气功能障碍和阻塞性通气功能减退。关键词：上气道咳嗽综合征 常见病因 鼻炎鼻窦炎腺样体肥大儿童2大连医科大学硕士学位论文Clinical Research of Upper Airway Cough Syndrome inChildrenMaster degree candidate：QiaozaixiaSupervisor：Professor Cui ZhenzeVicesupervisor：HuangyanMajor：PediatricsAbstractobjeetiveTo realize common causes，clinical sign and symptoms，diagnosis，differentialdiagnosis，and distribution difference regarding to age groups，of upper airway coughsyndrome in childrenMethodsRetrospective analysis method in children was done to confirm childrenS upperairway cough syndromeThe total cases(55)which conform tO the standard of thedisease were carried out in September 2010 to March 2013 from respiratory andoutpatient departments in Dalian children hospitalWe summarized and analyzed theclinical manifestations，CT features and the common causes of the disease：And weregistered and recorded the information in the case tableResults1Children with upper airway cough syndrome have a total of 55 cases，preschoolgroup 36 cases(65)，School age group 1 9 cases(35)2There were 55 children with upper airway cough syndrome，38 with single cause，1 4 with two causes and 3 with more tlall two causesCommon cause constituent ratioto sinusitis，rhinitis，adenoid hypertrophy and laryngeal diseases accounted for 453373，16，and 14respectivelyEtiology of Upper airway cough syndromeinvolved preschool and school-age group both group having sinusitis，rhinitis，adenoidhypertrophy and throat diseasesIn preschool group adenoid hypertrophy WaS the majorrelated cause whereas rhinitis and sinusitis were considered as leading cause in schoolage group3All ofthe 55 children with upper airway cough syndrome had COU曲，besides，509of the children accompanied with major symptoms such as sneezingnasal3一 奎堡垦翌奎堂堡主兰垡丝壅 congestion455of the children have positive signs，among it the children have signssuch as purulent secretions(37)，sinus tendemess(34)and Pebbles(29)respectively4Among the 55 children with upper airway cough syndrome，there are thirty fourchildren were diagnosed aS sinusitis by doing CT examination，among them 27maxillary sinus，2 ethrnoid sinus，1 maxillary sinus with ethmoid sinus，and 4 maxillarysinus，ethmoid sinus and sphenoid sinus involvement were diagnosedMaxillarysinusitis has the highest rate of involvement(744)，but ethrnoid sinusitis andsphenoid sinusitis were having less involvement(163and 93)5Among the 55 children埘tll upper airway cough syndrome，lung function testwas done for 37 childrenAmong these children the test was(59)normal，and the testwas(4 1)abnormal，it followed by small airway ventilation WaS reduced，mixed lungventilation dysfunction and obstructive ventilation dysfunctionEach accounted for40，33and 27Conclusions1The age distribution of childrenS upper airway cough syndrome mainly waspreschool groupsThe common causes were sinusitis，rhinitis，adenoid hypertrophy andlaryngeal diseasesAdenoid hypertrophy was high proportion in preschool age andrhinitis、im sinusitis was high proportion in the school age group2While all the children with upper airway cough syndrome have coughhalf ofthem have nasal symptoms such as sneezing and nasal congestion，and about half ofthem have positive signs，followed by throat wall purulent secretions，sinus areatenderness or pebbles3In the children with upper airway cough syndrome caused by sinusitisabout 45WaS having maxillary sinus lesions4In the children with upper airway cou