中国儿童慢性咳嗽的治疗现状
중국인동만성해수적치료현상
Current status of chronic cough treatment in Chinese children
  • 万方数据
    中华儿科杂志 중화인과잡지
    Chinese Journal of Pediatrics
    2014年 3期 163-171 ,共9页

    中国儿童慢性咳嗽病因构成比研究协作组%董晓艳%陆权%吴蓓蓉%张丽娜%袁东

    중국인동만성해수병인구성비연구협작조%동효염%륙권%오배용%장려나%원동

    治疗%咳嗽%中国儿童 治療%咳嗽%中國兒童
    치료%해수%중국인동
    Treatment%Cough%Child
    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.
    목적 료해중국인동만성해수적치료현상,위기규범합리치료제공증거.방법 근거인과호흡학조2008년《인동만성해수진단여치료지남》적표준,우2009년5월지2010년4월간,대19개성시29소의원진단만성해수적4 582례문진환인분별재입선후반개월、1개월화3개월진행수방,수집약물치료신식.소유수거균통과Epidata3.0연건수입,통과SPSS19.0연건작통계학분석,조간비교채취방차분석화비삼수분석,이P치＜0.05대표차이유통계학의의.결과 합격병례4 529례,합격솔98.8％.만성해수전3위병인의차위해수변이성효천(CVA)、상기도해수종합정화호흡도감염후해수.합격병례수진즉급여약물치료자3 537례(77.2％),부수진관찰이미여용약자1 044례(22.8％).수방기준순의촉견지용약자2 524례(55.1％),미능견지자2 057례(44.9％).CVA수진용약적전3위빈수배서의차위백삼희수체길항제(81.68％)、항조알약(50.53％)화β2수체격동제(37.77％);수방시간적연속,현시흡입당피질격소적사용솔재상승,지3개월시이렬제2위(10.74％);각류약물단독사용적료효간차이무통계학의의(P =0.092 ＞0.05),연합용약지간존재차이(P =0.006 ＜0.05),β2수체격동제재CVA적진단화치료중유착특수적지위.상기도해수종합정수진49.80％병례사용항균약물,수방기항균약물사용신속하강,이흡입당피질격소유소상승;연합용약료효분석:이항조알약、백삼희수체길항제연합흡입당피질격소료효최호(P=0.036＜0.05).호흡도감염후해수환인61.35％재입선전이사용항균약물,여CVA비교차이유통계학의의(P=0.000 1 ＜0.01),항균약물사용솔수진단명학이하강,선택β내선알류억혹대배내지류약물,료효차이통계학상병무현저의의(P=0.052 ＞0.05).결론 중국인동만성해수치료용약적선택존재다양성,여병인구성비적중첩、다병인、동태수정진단이급각지역약원、용약습관등균유관.목전,백삼희수체길항제재인동만성해수용약중거수위,단용우CVA치료,기여β2수체격동제、항조알약적단약료효상비교병무명현우세.흡입당피질격소재인동만성해수치료용약중상미엄범인지,즉사재CVA;이항균약물적합리사용유진보,인과의생대만성해수적인식재가강.잉응강조만성해수적관찰、등대화수방원칙.취CVA적료효판정,1～3개월수방기대부분환인상혐불족,가고필괄당연장,이다병인소치적병례경수요연장관찰시간.
    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' 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.
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