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 characteristics and treatment of chronic cough in children and provide clinical basis for standardized treatment of the disease in Fuzhou area of Fujian province. Methods According to the 2008 Guideline of the diagnosis and treatment of chronic cough in children,364 qualified cases were collected and completed follow-up in Department of Allergy of Fuzhou Children's Hospital.All data were statistical analyzed through SPSS 19.0 software. Results 1)In the qualified cases of chronic cough,the leading three etiologies were cough variant asthma (CVA,47.0%),upper airway cough syndrome (UACS,28.6%),and post-infection cough (PIC,15.9%).2)Clinical characteristics were analyzed in the etiologies of chronic cough:coughing fit time CVA at night (75.7%),UACS early in the morning (74.8%) and PIC during the day (80.4%),gastroesophageal reflux cough (GERC) at night (88.2%).3)The etiologies of chronic cough were treat with 3~4 kinds of drugs in the first visit 246 (67.58%),more than 5 kinds of drugs in the first visit 28 (7.69%)(χ²=416.894,P＜0.001).4)The etiologies of chronic cough used drugs in the first visit and followed up for 3 months:CVA were given priority to antihistamines and leukotriene.UACS and PIC were given priority to antibiotic and antihistamines.GERC were given priority to promoting gastric dynamics medicine and Inhibiting gastric acid drugs. Conclusions 1)The etiologies of chronic cough have different characteristics,to guide the clinical diagnosis and treatment in the first visit according to its characteristics.2)The diversity of chronic cough medicine in Fuzhou was area related to the complexity of the etiologies of chronic cough,correcting diagnosis dynamically,the habits of using drug,etc.It reminded clinicians to attach great importance to the observation of cough therapeutic effect,regular follow-up,correcting diagnosis timely and adjusting the medication.