小儿肺部感染合并胃食管返流的影响因素及其临床特征分析
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摘要
目的探讨小儿肺部感染合并胃食管返流(Gastroesophageal reflux, GER)的影响因素并对其临床特征进行分析.方法选取2015-03/2017-08常山县人民医院收治的139例肺部感染患儿作为实验组,选择同期于我院进行体检的98例儿童作为参照组.对所有儿童进行24 h食管pH监测,比较两组GER发生情况,分析肺部感染与GER的关系并通过Logisitic回归分析两者发生的影响因素,观察肺部感染合并GER患儿的临床特征.结果实验组的反流次数、平均每次反流时间、最长反流时间、酸消除时间、酸暴露时间百分率、BoixOchoa计分及GER阳性率均明显高于参照组(均P <0.05).对139例肺部感染患儿各项指标进行单因素分析,结果显示影响肺部感染并发GER的因素为患儿的年龄、病情严重程度、慢性咽炎及镇静药物使用情况(均P<0.05),患儿性别对肺部感染并发GER无影响(P>0.05); Logisitic回归分析结果表明,患儿的年龄、病情严重程度、慢性咽炎及镇静药物使用情况均可以影响肺部感染合并GER的发生(均P<0.05). 56例肺部感染并发GER的患儿中,有29例出现咳嗽, 21例出现溢乳, 11例出现呕吐, 8例出现哭闹拒食, 6例出现呛奶, 5例出现喘鸣, 2例出现喘息;其中有13例同时存在咳嗽及溢乳症状, 7例同时存在咳嗽及呕吐症状,6例同时存在咳嗽及哭闹拒食症状,4例同时存在咳嗽及呛奶症状.有29例(51.79%)患儿合并基础疾病:11例喉软化,牛奶过敏和先天性心脏病各5例,3例运动发育迟缓,漏斗胸和食道裂孔疝各2例,营养不良l例.结论小儿肺部感染并发GER的发病率明显较高,患儿年龄,肺部感染严重程度、慢性咽炎及镇静药物使用情况是影响其发生的危险因素,且患儿多存在基础疾病;肺部感染患儿临床伴有咳嗽、溢乳、呕吐、哭闹拒食、呛奶及喘鸣等表现时可考虑GER.
AIM To explore the influencing factors and clinical features for pulmonary infection complicated with gastroesophageal reflux(GER) in children. METHODS A total of 139 children with pulmonary infection admitted to Changshan County People's Hospital from March 2015 to August 2017 were selected as an experimental group and 98 children who were examined at our hospital during the same period were selected as a reference group. All children were monitored for 24-h esophageal pH. The relationship between pulmonary infection and GER was analyzed, and Logistic regression method was used to analyze the influencing factors on them. The clinical features of children with pulmonary infection complicated with GER were summarized. RESULTS The number of reflux episodes, mean time to reflux, longest reflux time, acid elimination time, acid exposure time, Boix-Ochoa score, and GER positive rate in the experimental group were significantly higher than those in the reference group(P < 0.05 for all). Univariate analysis showed that the factors influencing pulmonary infection complicated with GER were age, severity of illness, chronic pharyngitis, and sedative drug use(P < 0.05 for all), but gender had no effect(P > 0.05). Logistic regression analysis showed that age, severity of illness, chronic pharyngitis, and sedation drug use in children affected the occurrence of pulmonary infection complicated with GER(P < 0.05 for all). Of the 56 children with GER who developed pulmonary infection,29 developed coughing, 21 developed galactorrhea, 11 developed vomiting, 8 developed crying and antifeedant, 6 developed choking, 5 developed wheezing, and 2 developed wheezing respiration. Among them, cough and galactorrhea were found in 13 cases, cough and vomit in 7 cases, cough and crying antifeedant in 6 cases, and cough and choking symptoms in 4 cases. There were 29(51.79%) children with underlying diseases: 11 cases of laryngeal softening, 5 cases of milk allergy and congenital heart disease each, 3 cases of exercise retardation, 2 cases of funnel chest and esophageal hiatus each, and 1 case of malnutrition. CONCLUSION The incidence of GER in children with pulmonary infection is high, and age, severity of pulmonary infection, chronic pharyngitis, and sedative drug use are risk factors affecting their occurrence. There are many basic diseases in these children. GER should be considered in children with pulmonary infection who have clinical symptoms associated with cough, galactorrhea, vomiting, crying and antifeedant, choking, and wheezing.
AIM To explore the influencing factors and clinical features for pulmonary infection complicated with gastroesophageal reflux(GER) in children. METHODS A total of 139 children with pulmonary infection admitted to Changshan County People's Hospital from March 2015 to August 2017 were selected as an experimental group and 98 children who were examined at our hospital during the same period were selected as a reference group. All children were monitored for 24-h esophageal pH. The relationship between pulmonary infection and GER was analyzed, and Logistic regression method was used to analyze the influencing factors on them. The clinical features of children with pulmonary infection complicated with GER were summarized. RESULTS The number of reflux episodes, mean time to reflux, longest reflux time, acid elimination time, acid exposure time, Boix-Ochoa score, and GER positive rate in the experimental group were significantly higher than those in the reference group(P < 0.05 for all). Univariate analysis showed that the factors influencing pulmonary infection complicated with GER were age, severity of illness, chronic pharyngitis, and sedative drug use(P < 0.05 for all), but gender had no effect(P > 0.05). Logistic regression analysis showed that age, severity of illness, chronic pharyngitis, and sedation drug use in children affected the occurrence of pulmonary infection complicated with GER(P < 0.05 for all). Of the 56 children with GER who developed pulmonary infection,29 developed coughing, 21 developed galactorrhea, 11 developed vomiting, 8 developed crying and antifeedant, 6 developed choking, 5 developed wheezing, and 2 developed wheezing respiration. Among them, cough and galactorrhea were found in 13 cases, cough and vomit in 7 cases, cough and crying antifeedant in 6 cases, and cough and choking symptoms in 4 cases. There were 29(51.79%) children with underlying diseases: 11 cases of laryngeal softening, 5 cases of milk allergy and congenital heart disease each, 3 cases of exercise retardation, 2 cases of funnel chest and esophageal hiatus each, and 1 case of malnutrition. CONCLUSION The incidence of GER in children with pulmonary infection is high, and age, severity of pulmonary infection, chronic pharyngitis, and sedative drug use are risk factors affecting their occurrence. There are many basic diseases in these children. GER should be considered in children with pulmonary infection who have clinical symptoms associated with cough, galactorrhea, vomiting, crying and antifeedant, choking, and wheezing.
引文
1罗燕军,周晓勤.儿童重症肺炎与胃食管反流关系的临床研究.中国小儿急救医学2013;20:530-532[DOI:10.3760/cma.j.issn.1673-4912.2013.05.031]
2 Kukulka M,Nudurupati S,Perez MC.Pharmacokinetics and safety of dexlansoprazole MR in pediatric patients with symptomatic gastroesophageal reflux disease.Clin Exp Gastroenterol 2014;7:461-471[PMID:25525378 DOI:10.2147/CEG.S67672]
3王翠玲,崔红,杨丽君.小儿胃食管反流病的诊断和治疗.中国医刊2013;48:4-7[DOI:10.3969/j.issn.1008-1070.2013.03.002]
4 Hegar B.Gastroesophageal reflux in infants.Southeast Asian J Trop Med Public Health 2014;45 Suppl 1:69-72[PMID:25423793]
5 Rosen R.Gastroesophageal reflux in infants:more than just a phenomenon.JAMA Pediatr 2014;168:83-89[PMID:24276411DOI:10.1001/jamapediatrics.2013.2911]
6陈全生.胃食管反流与慢性咽喉炎探究.心血管病防治知识(下半月)2015;26:146-147
7黄梅.小儿肺炎支原体肺炎临床表现及发病机制分析.中国妇幼保健2014;29:223-225[DOI:10.7620/zgfybj.j.issn.1001-4411.2014.02.24]
8董佳璐,尚占民.胃食管反流病治疗的药物选择及注意事项.临床内科杂志2016;33:371-374[DOI:10.3969/j.issn.1001-9057.2016.06.003]
9 Perry KA,Pham TH,Spechler SJ,Hunter JG,Melvin WS,Velanovich V.2014 SSAT State-of-the-Art Conference:advances in diagnosis and management of gastroesophageal reflux disease.J Gastrointest Surg 2015;19:458-466[PMID:25519085 DOI:10.1007/s11605-014-2724-9]
10 Lightdale JR,Gremse DA;Section on Gastroenterology,Hepatology,and Nutrition.Gastroesophageal reflux:management guidance for the pediatrician.Pediatrics2013;131:e1684-e1695[PMID:23629618 DOI:10.1542/peds.2013-0421]
11滕晋,王一平,王丹.胃食管反流病与慢性咽炎关系的临床研究.中医眼耳鼻喉杂志2015;5:7-8[DOI:10.3969/j.issn.1674-9006.2015.01.004]
12周春燕.呼吸机相关性肺炎与胃食管反流的相关性分析.海南医学院学报2016;22:141-143[DOI:10.13210/j.cnki.jhmu.20150918.007]
13林道炯.小儿肺炎合并胃食管反流的影响因素分析.广东医学2016;37:1862-1863
14陈卿奇,羊文芳,吴素江,何文,李威,余勇,吴亮,张润顺.海南西部地区胃食管反流病患者的临床特征及相关危险因素研究.海南医学2017;28:1067-1070[DOI:10.3969/j.issn.1003-6350.2017.07.013]
15苑丽双,聂军红.小儿肺炎合并胃食管反流发生现况及其影响因素调查.临床肺科杂志2017;22:2019-2021[DOI:10.3969/j.issn.1009-6663.2017.11.023]
16李磊.反流性咽喉炎与胃食管反流病的关系研究.中国伤残医学2015;30:42-43[DOI:10.13214/j.cnki.cjotadm.2015.18.028]
17胡志伟,吴继敏,汪忠镐.胃食管反流病的现状诊治难点及对策.中华医学杂志2016;96:988-992[DOI:10.3760/cma.j.issn.0376-2491.2016.12.021]
18李松霏,李文波,范飞飞,刘晓峰.难治性胃食管反流病的治疗进展.胃肠病学2017;22:439-442[DOI:10.3969/j.issn.1008-7125.2017.07.014]
19王文建,徐建强,郑跃杰.伴肺部炎症的婴儿胃食管反流临床特征.国际儿科学杂志2015;42:713-715[DOI:10.3760/cma.j.issn.1673-4408.2015.06.031]
20张国玲.胃食管反流病患者的临床特征及其预后的影响因素分析.中国综合临床2016;32:1009-1012[DOI:10.3760/cma.j.issn.1008-6315.2016.11.012]
2 Kukulka M,Nudurupati S,Perez MC.Pharmacokinetics and safety of dexlansoprazole MR in pediatric patients with symptomatic gastroesophageal reflux disease.Clin Exp Gastroenterol 2014;7:461-471[PMID:25525378 DOI:10.2147/CEG.S67672]
3王翠玲,崔红,杨丽君.小儿胃食管反流病的诊断和治疗.中国医刊2013;48:4-7[DOI:10.3969/j.issn.1008-1070.2013.03.002]
4 Hegar B.Gastroesophageal reflux in infants.Southeast Asian J Trop Med Public Health 2014;45 Suppl 1:69-72[PMID:25423793]
5 Rosen R.Gastroesophageal reflux in infants:more than just a phenomenon.JAMA Pediatr 2014;168:83-89[PMID:24276411DOI:10.1001/jamapediatrics.2013.2911]
6陈全生.胃食管反流与慢性咽喉炎探究.心血管病防治知识(下半月)2015;26:146-147
7黄梅.小儿肺炎支原体肺炎临床表现及发病机制分析.中国妇幼保健2014;29:223-225[DOI:10.7620/zgfybj.j.issn.1001-4411.2014.02.24]
8董佳璐,尚占民.胃食管反流病治疗的药物选择及注意事项.临床内科杂志2016;33:371-374[DOI:10.3969/j.issn.1001-9057.2016.06.003]
9 Perry KA,Pham TH,Spechler SJ,Hunter JG,Melvin WS,Velanovich V.2014 SSAT State-of-the-Art Conference:advances in diagnosis and management of gastroesophageal reflux disease.J Gastrointest Surg 2015;19:458-466[PMID:25519085 DOI:10.1007/s11605-014-2724-9]
10 Lightdale JR,Gremse DA;Section on Gastroenterology,Hepatology,and Nutrition.Gastroesophageal reflux:management guidance for the pediatrician.Pediatrics2013;131:e1684-e1695[PMID:23629618 DOI:10.1542/peds.2013-0421]
11滕晋,王一平,王丹.胃食管反流病与慢性咽炎关系的临床研究.中医眼耳鼻喉杂志2015;5:7-8[DOI:10.3969/j.issn.1674-9006.2015.01.004]
12周春燕.呼吸机相关性肺炎与胃食管反流的相关性分析.海南医学院学报2016;22:141-143[DOI:10.13210/j.cnki.jhmu.20150918.007]
13林道炯.小儿肺炎合并胃食管反流的影响因素分析.广东医学2016;37:1862-1863
14陈卿奇,羊文芳,吴素江,何文,李威,余勇,吴亮,张润顺.海南西部地区胃食管反流病患者的临床特征及相关危险因素研究.海南医学2017;28:1067-1070[DOI:10.3969/j.issn.1003-6350.2017.07.013]
15苑丽双,聂军红.小儿肺炎合并胃食管反流发生现况及其影响因素调查.临床肺科杂志2017;22:2019-2021[DOI:10.3969/j.issn.1009-6663.2017.11.023]
16李磊.反流性咽喉炎与胃食管反流病的关系研究.中国伤残医学2015;30:42-43[DOI:10.13214/j.cnki.cjotadm.2015.18.028]
17胡志伟,吴继敏,汪忠镐.胃食管反流病的现状诊治难点及对策.中华医学杂志2016;96:988-992[DOI:10.3760/cma.j.issn.0376-2491.2016.12.021]
18李松霏,李文波,范飞飞,刘晓峰.难治性胃食管反流病的治疗进展.胃肠病学2017;22:439-442[DOI:10.3969/j.issn.1008-7125.2017.07.014]
19王文建,徐建强,郑跃杰.伴肺部炎症的婴儿胃食管反流临床特征.国际儿科学杂志2015;42:713-715[DOI:10.3760/cma.j.issn.1673-4408.2015.06.031]
20张国玲.胃食管反流病患者的临床特征及其预后的影响因素分析.中国综合临床2016;32:1009-1012[DOI:10.3760/cma.j.issn.1008-6315.2016.11.012]