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目的通过了解福建省福州地区儿童慢性咳嗽临床特征和治疗情况,为慢性咳嗽诊断的流程建立及规范化治疗提供临床依据。方法根据中华医学会儿科学分会呼吸学组2008年制定的《中国儿童慢性咳嗽诊断与治疗指南》的标准,对福建省福州儿童医院变态反应专科收集诊断慢性咳嗽的合格病例364例进行随访。所有数据通过SPSS 19.0软件作统计学分析。结果 1)慢性咳嗽前3位病因分别为咳嗽变异性哮喘(CVA,47.0%)、上气道咳嗽综合征(UACS,28.6%)、呼吸道感染后咳嗽(PIC,15.9%)。2)各病因慢性咳嗽发作时间:CVA夜间(75.7%)、UACS清晨(74.8%)、PIC白天(80.4%)、胃食管反流性咳嗽(GERC)(夜间88.2%)。3)各病因慢性咳嗽首诊3~4种药物联合治疗246例(67.58%)、5种以上药物联合治疗28例(7.69%)(χ2=416.894,P<0.001)。4)各病因慢性咳嗽首诊和3个月随访用药情况:CVA以抗组胺类、白三烯受体拮抗剂为主;UACS和PIC以抗生素类、抗组胺类为主;GERC以促胃动力药、抑酸药为主。结论 1)各病因慢性咳嗽的临床咳嗽特征不尽相同,根据其特点可指导临床首次诊断和治疗。2)福州地区慢性咳嗽用药的多样性与慢性咳嗽病因构成复杂性、动态修正诊断、用药习惯等因素相关,提醒临床医生诊治慢性咳嗽重视临床疗效观察、定期随访、及时修正诊断、调整用药。
Objective To understand the clinical features and treatment of chronic cough in children in Fuzhou, Fujian Province, and to provide a clinical basis for the establishment and standardization of chronic cough diagnosis. Methods According to the “Guidelines for Diagnosis and Treatment of Chronic Cough in Children in China” formulated by the Respiratory Group of Pediatrics Branch of Chinese Medical Association in 2008, 364 qualified cases of chronic cough were collected from Department of Allergy, Fuzhou Children ’s Hospital of Fujian Province. All data were statistically analyzed by SPSS 19.0 software. Results 1) The first three causes of chronic cough were cough variant asthma (CVA, 47.0%), upper airway cough syndrome (UACS, 28.6%) and cough after respiratory infection (PIC, 15.9%). 2) The causes of chronic cough onset were CVA night (75.7%), UACS early morning (74.8%), PIC daytime (80.4%) and GERC (88.2% at night). 3) 246 cough (67.58%) were treated with 3 to 4 drugs in all causes of chronic cough, and 28 (7.69%) were treated with 5 or more drugs (χ2 = 416.894, P <0.001). 4) The cause of the first diagnosis of chronic cough and 3 months follow-up medication: CVA with antihistamines, leukotriene receptor antagonist based; UACS and PIC with antibiotics, antihistamines; GERC to promote Gastric drugs, acid-based drugs. Conclusions 1) The clinical cough characteristics of chronic cough vary in different etiologies. According to its characteristics, it can guide the first clinical diagnosis and treatment. 2) The diversity of chronic cough medication in Fuzhou is related to the causes of chronic cough, complexity of dynamic complication diagnosis, medication habits and other factors. It reminds clinicians to pay attention to the clinical curative effect of chronic cough, follow up regularly, and timely correct the diagnosis and adjust medication.