儿童咽喉反流的特点及诊治初探  

Clinical manifestations in pediatric laryngopharyngeal reflux

作　　者：李兰[1] 赵宇[1] 马翔宇[1] 张德伦[1] 吴泽斌[1] 陈珊[1] 

机构地区：[1]深圳市儿童医院耳鼻咽喉科,广东深圳518026

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第15期1145-1148,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：深圳市医学重点学科建设资助(No:2005C03);深圳市科技创新委员会资助(No:2013)

摘　　要：目的：研究儿童咽喉反流的临床表现特点,为进一步诊断和治疗提供参考。方法：选择反复上呼吸道感染、声嘶、咳嗽等具有3个月以上病史的患儿62例,进行反流症状指数量表检查、反流检查评分、食管24h pH监测,对其中2项以上阳性结果的患儿给予诊断性治疗,诊断性治疗有效患儿继续系统治疗。结果：62例患儿均进行RSI和RFS评分,RSI阳性57例,阳性率91.94%,症状发生频率依次为声嘶90.32%,痰多或鼻涕倒流77.42%,吞咽困难74.19%,上腹或胸部烧灼感72.58%,清嗓64.52%,咳嗽56.45%,呼吸困难51.61%,咽异物感48.39%;RFS阳性49例,阳性率79.03%,依次表现为杓会厌襞内侧红斑100%,声带水肿75.81%,弥漫性喉水肿50.00%,后连合肥厚33.87%,声门下水肿0.49%,未见肉芽肿。食管24hpH监测52例,阳性16例（30.76%）,均表现为直立位反流次数明显多于卧位及餐时和餐后。诊断性治疗62例,有效53例,阳性率85.48%;42例治疗时间为1~2个月,11例≥3个月。结论：儿童咽喉反流症状表现多样、不典型;反流症状指数量表检查结合反流检查评分具有较高的诊断灵敏性和特异性;治疗上需提醒患者注意日常饮食和进行抗酸治疗。Objective：To explore the clinical manifestations in pediatric laryngopharyngeal reflux and to provide more information on diagnosis and treatment.Method：Sixty-two cases with recurrent respiratory infections,hoarseness and chronic cough were examined with reflux symptom index（RSI）,reflux finding score（RFS）,and 24-hour pH monitoring.Those who had at least two positive test for reflux were given PPI for diagnostic therapy.Result：All patients completed reflux symptom index（RSI）questionnaire and underwent fiberoptic laryngoscopy,and reflux finding score（RFS）was evaluated.The positive rate of RSI and RFS was 91.94%and 79.03%differently.24-hours pH monitoring and diagnostic therapy was about 30.76%and 85.48% differently.The symptoms show hoarseness 90.32%,postnasal drip 77.42%,difficulty swallowing 74.19%,abdominal pain and chest pain72.58%,throat clearing 64.52%,chronic cough 56.45%,dysphagia 51.61%,throat abnormal feeling 48.39%.Laryngoscope examination shows inter-arytenoid erythema 100%,vocal mucosal oedema 75.81%,diffuse laryngeal edema 50.00%,posterior commissure hypertrophy 33.87%,subglottic edema 4.84%,no granuloma case.There was 16cases showing positive in 24-hours pH monitoring test.The positive rate was 30.76%.All cases accepted diagnostic therapy.Fifty-three cases were effective.The positive rate was 85.48%.Conclusion：There are no clinical presentations specific to pediatric laryngopharyngeal reflux.Patients often present with a wide range of atypical symptoms and signs.RSI questionnaire and RFS may provide diagnostic datas.Primary treatment includes lifestyle and medical therapy.

关 键 词：儿童 咽喉反流 反流症状指数量表 反流检查评分 

分 类 号：R766[医药卫生—耳鼻咽喉科]