儿童百日咳综合征临床特征及重视胃扭转致胃食管反流的发生对小婴儿百日咳综合征的影响:附807例病例分析  

Clinical characteristics of children with pertussis syndrome and attention to the effect of gastroesophageal reflux caused by gastric volvulus on small infants with pertussis syndrome: an analysis of 807 cases

作　　者：郑文彬 熊小丽[1] 周俪姗[1] 张林利 王育继[1] 鄢素琪[1] Zheng Wenbin;Xiong Xiaoli;Zhou Lishan;Zhang Linli;Wang Yuji;Yan Suqi(Wuhan Children's Hospital, Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, HuazhongUniversity of Science & Technology, Wuhan 430016, Hubei, China;Hubei University of Chinese Medicine, Wuhan 430065, Hubei, China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院,武汉市妇幼保健院,湖北武汉430016 [2]湖北中医药大学,湖北武汉430065

出　　处：《中国中西医结合急救杂志》2018年第6期567-573,共7页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：武汉市医药卫生临床重点学科研究项目(WZ12C08);武汉市黄鹤英才(医疗卫生)计划项目(武人才办〔2017〕2).

摘　　要：目的观察小儿百日咳综合征的临床特征及小婴儿胃食管反流对百日咳综合征的影响,为提高临床疗效提供经验。方法①回顾性分析2015年1月至2017年6月在武汉儿童医院治疗的807例诊断为百日咳综合征患儿的病例资料,通过归纳其症状、体征及相关理化检查,总结其临床特征。②采取前瞻性随机对照研究方法,选取2017年6月至2018年6月在武汉儿童医院治疗、年龄<6月、诊断为百日咳综合征,同时有胃扭转、胃食管反流的患儿120例,按确诊顺序随机分为研究组及对照组各60例。对照组采用常规治疗,研究组在常规治疗基础上加用手法整复胃扭转和抗反流治疗,观察两组患儿的临床疗效。结果①回顾性分析显示,儿童百日咳综合征的发生在临床上以<6个月的患儿多见,占88.30%(713例);全部病例均有痉挛性咳嗽,60.00%(484例)以夜间咳嗽更为明显。实验室检查显示,83.27%(672例)患儿有血小板升高,25.03%(202例)有心肌酶谱异常,70.38%(568例)有白细胞升高。病原学检查只有34.8%的患儿发现了病原菌,主要为单一病原感染为主(占86.12%)。胸片提示71.50%存在肺炎;73.00%患儿存在胃食管反流,其中又有77.92%合并胃扭转。②前瞻性研究显示,在小婴儿百日咳综合征合并胃扭转、胃食管反流患儿的治疗中,及时采用手法按摩整复胃扭转以及抗反流治疗的研究组患儿在改善痉咳症状所需时间(d:5.36±1.40比6.59±1.56,P<0.01)及缩短住院时间(d:6.50±1.41比8.09±1.63,P<0.01)方面均优于对照组。研究组病程中发生呼吸衰竭例数低于对照组(2例比8例,P<0.05)。结论百日咳综合征以淋巴细胞比例增高为主的白细胞升高,是甑别其与小婴儿肺炎合并胃扭转、胃食管反流的重要指标,注重血小板升高对百日咳综合征预后的提示作用。对于百日咳综合征病程中检测的病原学阳性是否是致病菌有待于进一步探讨。重视小婴儿百日�Objective To observe the clinical characteristics of infants with pertussis syndrome and theinfluence of gastroesophageal reflux (GER) on pertussis syndrome in small infants, and provide experience for improvingcurative effect. Methods ① The clinical data of 807 infants with pertussis syndrome treated at Wuhan Children'sHospital from January 2015 to June 2017 were retrospectively analyzed, in which their clinical characteristics includingsymptoms, signs and related physical and chemical examinations were summarized. ② Prospective randomizedcontrolled trials were performed at the Children's Hospital of Wuhan from June 2017 to June 2018, there were 120 infantswith ages < 6 months diagnosed as pertussis syndrome and simultaneously accompanied by gastric volvulus (GV) andGER, and they were randomly divided into a study group and a control group according to the date sequence of definitediagnosis, 60 cases in each group. The control group was given conventional medical treatment, while in the study group,additionally the infants received massage to restore gastric proper position and anti-reflux therapy. The clinical efficaciesof two groups were observed. Results ① Retrospective analysis showed that clinically, pertussis syndrome commonlyoccurred in infants of ages < 6 months, accounting for 88.30% (713 cases); all cases had spastic cough, and 60.00%(484 cases) infants' coughing was severer at night. In laboratory examinations, 83.27% (672 cases) of the infants hadelevated platelets (PLT), 25.03% (202 cases) had abnormal myocardial zymograms, and 70.38% (568 cases) had elevatedwhite blood cells (WBC). In the pathogen examination, only were pathogens found in 34.8% infants, mainly singlepathogen infection, accounting for 86.12%. Chest radiographs suggested 71.50% of infants with pneumonia, and 73.00%of infants with GER, among which 77.92% of infants were accompanied by GV. ② The prospective study showed thatin the treatment of infants with pertussis syndrome accompanied by GV and GER, manual massage should be u

关 键 词：百日咳综合征 临床特征 胃扭转胃食管反流 手法整复胃扭转 抗反流治疗 

分 类 号：R725.156[医药卫生—儿科]