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。
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 November 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 improve.After admission to our hospital,a lung function examination was performed,indicating ventilation dysfunction and positive 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 nebulization inhalation,partial intravenous infusion of glucocorticoids,and oral administration of Montelukast Sodium.No recurrence 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,clinicians should strengthen their understanding of CVA,raise their vigilance,inquire about relevant history in detail,and conduct specific examination in time.
作者
陈勇军
万光平
CHEN Yongjun;WAN Guangping(Department of Pediatrics,Maternal and Child Health and Family Planning Service Center,Dongpo District,Meishan,Sichuan 620000,China;Department of Pediatrics,People's Hospital of Meishan City,Meishan,Sichuan 620000,China)
出处
《临床误诊误治》
CAS
2023年第9期10-13,共4页
Clinical Misdiagnosis & Mistherapy
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
Cough variant asthma
Children
Misdiagnosis
Upper respiratory tract infection
Bronchitis
Pneumonia,mycoplasma
Bronchodilation test
Respiratory function tests
