摘要
目的 了解中国儿童慢性咳嗽的治疗现状,为其规范合理治疗提供证据.方法 根据儿科呼吸学组2008年《儿童慢性咳嗽诊断与治疗指南》的标准,于2009年5月至2010年4月间,对19个省市29所医院诊断慢性咳嗽的4 582例门诊患儿分别在入选后半个月、1个月和3个月进行随访,收集药物治疗信息.所有数据均通过Epidata3.0软件输入,通过SPSS19.0软件作统计学分析,组间比较采取方差分析和非参数分析,以P值＜0.05代表差异有统计学意义.结果 合格病例4 529例,合格率98.8％.慢性咳嗽前3位病因依次为咳嗽变异性哮喘（CVA）、上气道咳嗽综合征和呼吸道感染后咳嗽.合格病例首诊即给予药物治疗者3 537例（77.2％）,仅随诊观察而未予用药者1 044例（22.8％）.随访期遵循医嘱坚持用药者2 524例（55.1％）,未能坚持者2 057例（44.9％）.CVA首诊用药的前3位频数排序依次为白三烯受体拮抗剂（81.68％）、抗组胺药（50.53％）和β2受体激动剂（37.77％）;随访时间的延续,显示吸入糖皮质激素的使用率在上升,至3个月时已列第2位（10.74％）;各类药物单独使用的疗效间差异无统计学意义（P =0.092 ＞0.05）,联合用药之间存在差异（P =0.006 ＜0.05）,β2受体激动剂在CVA的诊断和治疗中有着特殊的地位.上气道咳嗽综合征首诊49.80％病例使用抗菌药物,随访期抗菌药物使用迅速下降,而吸入糖皮质激素有所上升;联合用药疗效分析：以抗组胺药、白三烯受体拮抗剂联合吸入糖皮质激素疗效最好（P=0.036＜0.05）.呼吸道感染后咳嗽患儿61.35％在入选前已使用抗菌药物,与CVA比较差异有统计学意义（P=0.000 1 ＜0.01）,抗菌药物使用率随诊断明确而下降,选择β内酰胺类抑或大环内酯类药物,疗效差异统计学上并无显著意义（P=0.052 ＞0.05）.结论 中国儿童慢性咳嗽治疗用药的选择存在多样性,与病因构成比的重叠、多病因、动态修正诊断以及各地域药源、用药习惯等均有关.目前,白三烯受体拮抗剂在儿童慢性咳嗽用药中居首位,但用于CVA治疗,其与β2受体激动剂、抗组胺药的单药疗效相比较并无明显优势.吸入糖皮质激素在儿童慢性咳嗽治疗用药中尚未广泛认知,即使在CVA;而抗菌药物的合理使用有进步,儿科医生对慢性咳嗽的认识在加强.仍应强调慢性咳嗽的观察、等待和随访原则.就CVA的疗效判定,1～3个月随访期对部分患儿尚嫌不足,可考虑适当延长,而多病因所致的病例更需要延长观察时间.
Objective To comprehensively understand the current situation of the treatment of chronic cough in Chinese children and provide evidence for a reasonable standard therapy.Method According to the 2008 Guideline of diagnosis and treatment of chronic cough in children that were formulated by The Subspecialty Group of Respiratory Diseases,the Society of Pediatrics,Chinese Medical Association and the Editorial Board of Chinese Journal of Pediatrics,the questionnaire of the cause of chronic cough in children was designed and 29 hospitals in 19 provinces,municipalities and autonomous regions were enrolled.Cases with chronic cough completed 3-month follow-up during May 2009 to April 2010 and information about drug treatment was collected.All data were input through Epidata 3.0 and SPSS19.0 software for statistical analysis.Result Totally 4 529 cases were eligible （the passing rate is 98.8%）.The leading three causes were cough variant asthma （CVA）,upper airway cough syndrome （UACS） and postinfectious cough （PIC）.The drug treatment was given to 3 537 cases （77.2%） at the first visit,and 1 044 cases （22.8%） were not given the treatment but were followed up for observation.In the follow-up period 2 524 cases adhered to medication （55.1%）,2 057 cases （44.9%） failed to adhere to treatment.The leading three medications in CVA patients was leukotriene receptor antagonists （81.68%）,antihistamines （50.53%） and beta 2 agonists （37.77%）.Follow-up showed that the use of inhaled corticosteroids （ICS） was on the rise and by the third month it was listed the second （10.74%）.No significant difference （P =0.092 〉 0.05） was found among the the effect of drugs used alone but there was significant difference among combinations （P =0.006）.Beta 2 agonists play a special role in the diagnosis and treatment of CVA.In UACS children,49.80% cases used antimicrobial agents at first visit.Follow-up showed rapid decrease of antimicrobial usage and ICS use increased to the second position.Antihistamines and leukotriene combined with inhaled corticosteroids scheme had the best effect,61.35% of PIC children were already given antimicrobial drugs before enrollment,compared with CVA （P =0.000 1） and the utilization rate declined with a clear diagnosis.The effects of beta lactams and macrolides had no significant difference （P =0.052）.Conclusion The choices of treatment for chronic cough in Chinese children are diverse,which is related to overlapping in etiology,diagnosis and the regional drug sources and habits in use of drugs.Currently,leukotriene receptor antagonists are at the first place in children with chronic cough medicine,but its effect was not significantly different from those of beta 2 agonists,antihistamines monotherapy.ICS has not been widely recognized in the treatment of children with chronic cough,even in the CVA.Rational use of antimicrobial agents has been improved.Pediatricians＆#39; understanding of chronic cough is being improved.We emphasize the principle of watching,waiting and follow-up in children with chronic cough.Effect on the determination of some CVA patients 1 to 3 months follow-up period is still too inadequate and may be considered appropriate to extend,while cases of multiple etiologies need to extend more observation and waiting time.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2014年第3期163-171,共9页
Chinese Journal of Pediatrics
基金
中华医学会临床医学慢性呼吸道疾病科研专项资金课题（08020760154）
