婴幼儿咽喉反流性疾病与持续喘息的关系探讨  

Relationship between laryngopharyngeal reflux diseases and persistent wheezing in infants and young children

作　　者：林丽华 陈幼芬[1] 孙秋凤[1] 陈莉莉[1] 陈丽羡[1] 吴谨准[1] 杨运刚[1] LIN Li-hua;CHEN You-fen;SUN Qiu-feng(Department of Pediatrics, the First Affiliated Hospital of Xiamen University,Xiamen, Fujian 361003 , China)

机构地区：[1]厦门大学附属第一医院儿科

出　　处：《中华全科医学》2019年第10期1701-1704,共4页Chinese Journal of General Practice

基　　金：福建卫生系统中青年骨干人才培养项目(2013-ZQN-JC-33)

摘　　要：目的探讨婴幼儿咽喉反流性疾病与持续喘息的关系,为持续喘息患儿的诊治提供一种思路。方法对持续喘息1个月以上且经门诊给予普米克令舒雾化治疗没有缓解的60例患儿收入院,并行纤维支气管镜及喉咽部24小时pH值检查。其中男45例,女15例,平均年龄为(9.93±0.82)个月;根据咽喉反流诊断标准分为咽喉反流组及无反流组;根据气管镜镜下表现分为气管软化组及无气管软化组。结果①气管镜检查结果提示所有患儿均有气管、支气管内膜炎症,且22例患儿有气管支气管软化(气管软化组),平均年龄为(8.13±5.65)个月;38例无气管支气管软化(无气管软化组),平均年龄为(10.92±5.59)个月,2组年龄比较差异无统计学意义。②根据Ryan指数,36例患儿有咽喉反流,发生率达60%。③气管软化组直立位时Ryan指数为197.67±228.19,明显高于无气管软化组(33.76±49.64),两者比较差异具有统计学意义(t=3.324,P=0.003)。④气管软化组和无气管软化组均有18例患儿符合咽喉反流诊断标准,咽喉反流的发生率分别为81.8%及47.4%,两者比较差异有统计学意义(χ^2=6.890,P=0.009)。结论咽喉反流是引起患儿持续喘息的重要原因,具有气管软化的持续喘息患儿,咽喉反流的发生率更高。Objective To investigate the relationship between laryngopharyngeal reflux diseases and persistent wheezing in infants and young children, and develop a new method for the diagnosis and therapy of persistent wheezing. Methods Total 60 infants suffering from persistent wheezing more than one month without remission after Pulmicort inhalation therapy in clinic were admitted. There were 45 males and 15 females, with a mean age of(9.93±0.82) months. The fiberoptic bronchoscopy and 24-hour laryngopharynx pH monitoring were performed in all patients. According to laryngopharyngeal reflux criteria, the infants were divided into the laryngopharyngeal reflux group and the non-reflux group, meanwhile, according to trachea under the bronchoscope, the patients were also divided into the tracheomalacia group and the non-tracheomalacia group. Results ①Bronchoscopy examination showed that all patients had endobronchial inflammation. The mean age of 22 cases of tracheobronchomalacia(tracheomalacia group) was(8.13±5.65) months, and of 38 cases of non-tracheobronchomalacia(non-tracheomalacia group) was(10.92±5.59) months, there was no significant difference in age of patients between the two group.②According to the index of Ryan, 36 cases were with laryngopharyngeal reflux, and the incidence rate of laryngopharyngeal reflux was 60%.③In the Tracheomalacia group, Ryan index was in the upright position(197.67±228.19), which was significantly higher than that of non-tracheomalacia group(33.76±49.64), the difference was statistically significant(t=3.324, P=0.003).④ There were 38 patients meeting the diagnostic criteria of laryngopharyngeal reflux(18 cases in each group) with the incidence of 81.8% and 47.4%, respectively, the difference was significant m(χ^2=6.890, P=0.009). Conclusion Laryngopharyngeal reflux is an important cause of persistent wheezing in infants and children. The incidence of laryngopharyngeal reflux is higher in children with persistent tracheomalacia.

关 键 词：咽喉反流 持续喘息 气管软化 婴幼儿 

分 类 号：R725.6[医药卫生—儿科]