咽喉反流与儿童慢性咳嗽的关系研究
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摘要
目的探讨咽喉反流(laryngopharyngeal reflux,LPR)与儿童慢性咳嗽的关系。方法选取2015年9月至2018年3月于首都儿科研究所附属儿童医院就诊的符合慢性咳嗽入组标准的患儿54例,对每例患儿均详细询问病史、体格检查、常规辅助检查及24h咽部pH值监测。所有存在LPR的患儿,均在针对已有病因治疗的基础上,给予饮食指导,必要时同时给予胃动力药物口服治疗,1个月后门诊复查患儿用药、咳嗽等症状情况。结果患儿男31例,女23例,年龄8个月～15岁,中位数年龄7.3岁。24h咽部p H值监测失败0例,7例(12.96%)患有LPR,其中合并咳嗽变异性哮喘2例。治疗1个月后回访发现,4例患儿症状消失,3例患儿症状好转。结论慢性咳嗽患儿中LPR发生率较高,LPR和儿童慢性咳嗽存在一定的相关性,同时治疗LPR有助于慢性咳嗽患儿症状的改善。
Objective To study the relationship between laryngopharyngeal reflux(LPR) and chronic cough in children. Method Children with chronic cough were recruited from September 2015 to March 2018, each patient was given detailed medical history review, physical examination, routine lab examination and 24-hour pH monitoring of pharynx. All the patients with LPR were given diet guidance and etiological treatments, and if necessary, they also were given gastric motility promoting drug. Patients with LPR were followed up and were asked about symptoms and taking medicines in 1 month. Result There were 54 children enrolled in the study, including 31 boys and 23 girls, and age was 8 months to 15 years old(P50 was 7.3). Results showed that no patient failed in 24-hour pH monitoring of pharynx,7 patients had LPR, and the incidence rate was 12.96%. In the patients with LPR, 2 cases were also diagnosed with cough variant asthma. After 1 month, in the patients with LPR, 4 cases recovered, 3 cases improved. Conclusion The incidence rate of LPR in children with chronic cough is high, and the treatment of LPR is helpful to improve the patients' symptoms. In a word, there is a certain correlation between LPR and chronic cough in children.
Objective To study the relationship between laryngopharyngeal reflux(LPR) and chronic cough in children. Method Children with chronic cough were recruited from September 2015 to March 2018, each patient was given detailed medical history review, physical examination, routine lab examination and 24-hour pH monitoring of pharynx. All the patients with LPR were given diet guidance and etiological treatments, and if necessary, they also were given gastric motility promoting drug. Patients with LPR were followed up and were asked about symptoms and taking medicines in 1 month. Result There were 54 children enrolled in the study, including 31 boys and 23 girls, and age was 8 months to 15 years old(P50 was 7.3). Results showed that no patient failed in 24-hour pH monitoring of pharynx,7 patients had LPR, and the incidence rate was 12.96%. In the patients with LPR, 2 cases were also diagnosed with cough variant asthma. After 1 month, in the patients with LPR, 4 cases recovered, 3 cases improved. Conclusion The incidence rate of LPR in children with chronic cough is high, and the treatment of LPR is helpful to improve the patients' symptoms. In a word, there is a certain correlation between LPR and chronic cough in children.
引文
[1]中华医学会儿科学分会呼吸学组慢性咳嗽协作组,《中华儿科杂志》编辑委员会.中国儿童慢性咳嗽诊断与治疗指南(2013年修订)[J].中华儿科杂志,2014,52(3):184-188.
[2]Ford CN.Evaluation and management of laryngopharyngeal reflux[J].JAMA,2005,294(12):1534-1540.
[3]中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组,中华医学会耳鼻咽喉头颈外科学分会咽喉学组.咽喉反流性疾病诊断与治疗专家共识(2015年)[J].中华耳鼻咽喉头颈外科杂志,2016,51(5):324-326.
[4]朱毅,陆丽华.孟鲁司特钠治疗小儿咳嗽变异性哮喘的疗效观察[J].中国临床医学,2009,16(4):259-260.
[5]Chang AB,Glomb WB.Guidelines for evaluating chronic cough in pediatrics:ACC pevidence based clinical practice guidelines[J].Chest,2006,129(1 Suppl):260S-283S.
[6]中国儿童慢性咳嗽病因构成比研究协作组.中国儿童慢性咳嗽病因构成比多中心研究[J].中华儿科杂志,2012,50(2):83-92.
[7]Fomumn HR,Ghafari M.Gastroesophageal reflux as cause of chronic respiratory symptoms[J].Indian J Pediatr,2002,69(2):137-139.
[8]刘峰,江米足,周雪莲,等.小儿慢性咳嗽与胃食管反流的关系[J].临床儿科杂志,2007,25(6):442-444.
[9]周名秀,邓力,李瑞琼.儿童慢性咳嗽与胃食管反流关系临床探讨[J].中国实用儿科杂志,2005,20(3):175-176.
[10]Koufman JA.The otolaryngologic manifestations of gastroesophageal reflux disease(GERD):a clinical investigation of225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury[J].Laryngoscope,1991,101(4 Pt2 Suppl 53):1-78.
[11]李兰.儿童咽喉反流[J].中华耳鼻咽喉头颈外科杂志,2014,49(5):436-440.
[12]张亚梅,杨小健.儿童咽喉反流[J].中国医学文摘(耳鼻咽喉科学),2010,25(5):243-246.
[13]李兰,赵宇,马翔宇,等.儿童咽喉反流的特点及诊治初探[J].临床耳鼻咽喉头颈外科杂志,2014,28(15):1145-1148.
[14]常丽,曹玲.咽喉反流与儿童呼吸系统疾病[J].中国医刊,2016,51(11):6-9.
[15]Baudoin T,Kosec A,Cor IS,et al.Clinical features and diagnostic reliability in paediatric laryngopharyngeal reflux[J].Int J Pediatr Otorhinolaryngol,2014,78(7):1101-1106.
[16]Mesallam TA.Oropharyngeal 24-hour pH monitoring in children with airway-related problems[J].Clin Exp Otorhinolaryngol,2016,9(2):168-172.
[2]Ford CN.Evaluation and management of laryngopharyngeal reflux[J].JAMA,2005,294(12):1534-1540.
[3]中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组,中华医学会耳鼻咽喉头颈外科学分会咽喉学组.咽喉反流性疾病诊断与治疗专家共识(2015年)[J].中华耳鼻咽喉头颈外科杂志,2016,51(5):324-326.
[4]朱毅,陆丽华.孟鲁司特钠治疗小儿咳嗽变异性哮喘的疗效观察[J].中国临床医学,2009,16(4):259-260.
[5]Chang AB,Glomb WB.Guidelines for evaluating chronic cough in pediatrics:ACC pevidence based clinical practice guidelines[J].Chest,2006,129(1 Suppl):260S-283S.
[6]中国儿童慢性咳嗽病因构成比研究协作组.中国儿童慢性咳嗽病因构成比多中心研究[J].中华儿科杂志,2012,50(2):83-92.
[7]Fomumn HR,Ghafari M.Gastroesophageal reflux as cause of chronic respiratory symptoms[J].Indian J Pediatr,2002,69(2):137-139.
[8]刘峰,江米足,周雪莲,等.小儿慢性咳嗽与胃食管反流的关系[J].临床儿科杂志,2007,25(6):442-444.
[9]周名秀,邓力,李瑞琼.儿童慢性咳嗽与胃食管反流关系临床探讨[J].中国实用儿科杂志,2005,20(3):175-176.
[10]Koufman JA.The otolaryngologic manifestations of gastroesophageal reflux disease(GERD):a clinical investigation of225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury[J].Laryngoscope,1991,101(4 Pt2 Suppl 53):1-78.
[11]李兰.儿童咽喉反流[J].中华耳鼻咽喉头颈外科杂志,2014,49(5):436-440.
[12]张亚梅,杨小健.儿童咽喉反流[J].中国医学文摘(耳鼻咽喉科学),2010,25(5):243-246.
[13]李兰,赵宇,马翔宇,等.儿童咽喉反流的特点及诊治初探[J].临床耳鼻咽喉头颈外科杂志,2014,28(15):1145-1148.
[14]常丽,曹玲.咽喉反流与儿童呼吸系统疾病[J].中国医刊,2016,51(11):6-9.
[15]Baudoin T,Kosec A,Cor IS,et al.Clinical features and diagnostic reliability in paediatric laryngopharyngeal reflux[J].Int J Pediatr Otorhinolaryngol,2014,78(7):1101-1106.
[16]Mesallam TA.Oropharyngeal 24-hour pH monitoring in children with airway-related problems[J].Clin Exp Otorhinolaryngol,2016,9(2):168-172.