儿童咳嗽变异性哮喘临床误诊分析
Clinical Misdiagnosis of Children with Cough Variant Asthma
陈勇军 1万光平2
作者信息
- 1. 620000 四川 眉山,眉山市东坡区妇幼保健计划生育服务中心儿科
- 2. 620000 四川 眉山,眉山市人民医院儿科
- 折叠
摘要
目的 分析儿童咳嗽变异性哮喘(CVA)的早期表现、临床特点及误诊原因.方法 回顾性分析 2019年11 月—2022 年1 月收治曾误诊的CVA患儿16 例的临床资料.结果 16 例均以慢性刺激性干咳为主要或唯一症状就诊,外院初步诊断为上呼吸道感染9 例、支气管炎5 例、支原体肺炎2 例,予相应治疗后患儿症状无好转.经行肺功能检查示通气功能障碍、支气管舒张试验阳性,皮肤变应原试验阳性 12 例,并结合个人过敏史和(或)家族过敏史和(或)哮喘家族史、诱因和发作特点确诊CVA.误诊时间2～4 个月.确诊后予沙丁胺醇联合布地奈德雾化吸入、部分加用糖皮质激素静脉滴注、孟鲁司特钠口服等治疗后症状消失、肺功能好转.随访 6 个月,均无复发.结论 CVA早期表现无特异性,肺部体征多不明显,误诊率较高.临床医生应加强对CVA的认识,提高警惕性,详细询问相关病史,及时行特异性检查,以提高本病早期诊断率.
Abstract
Objective To analyze the early manifestations,clinical characteristics,and causes of misdiagnosis of cough variant asthma(CVA)in children.Methods Clinical data of 16 children with misdiagnosed CVA admitted from No-vember 2019 to January 2022 were retrospectively analyzed.Results All 16 cases presented with chronic irritating dry cough as the main or only symptom.Nine cases were diagnosed with upper respiratory tract infection,5 cases with bronchitis,and 2 cases with mycoplasma pneumonia in other hospitals.After corresponding treatment,the symptoms of the children did not im-prove.After admission to our hospital,a lung function examination was performed,indicating ventilation dysfunction and posi-tive bronchodilator test.Twelve cases were positive for skin allergen test,and CVA was diagnosed based on personal allergy history and/or family history of allergy and asthma,triggers,and onset characteristics.The misdiagnosis lasted 2-4 months.After diagnosis,the symptoms disappeared and lung function improved after treatment with Salbutamol and Budesonide nebu-lization inhalation,partial intravenous infusion of glucocorticoids,and oral administration of Montelukast Sodium.No recur-rence was reported at 6-month follow-up.Conclusion In the early stage of CVA,there is no specific early manifestation,nor obvious pulmonary signs,and the early misdiagnosis rate is high.In order to improve the early diagnosis rate of CVA,clini-cians should strengthen their understanding of CVA,raise their vigilance,inquire about relevant history in detail,and conduct specific examination in time.
关键词
咳嗽变异性哮喘/儿童/误诊/上呼吸道感染/支气管炎/肺炎,支原体/支气管舒张试验/呼吸功能试验Key words
Cough variant asthma/Children/Misdiagnosis/Upper respiratory tract infection/Bronchitis/Pneumonia,mycoplasma/Bronchodilation test/Respiratory function tests引用本文复制引用
出版年
2023
国家科技期刊平台
NSTL
万方数据