如何从儿童慢性湿性咳嗽中甄别出迁延性细菌性支气管炎

摘要

慢性咳嗽是儿童的常见症状,其中慢性湿性咳嗽尤其困扰着儿童健康.由于迁延性细菌性支气管炎(PBB)是儿童慢性湿性咳嗽的常见病因,故早期从慢性湿性咳嗽患儿中甄别出PBB尤其重要.现介绍PBB的临床特征和诊断线索及其基于微生物的诊断标准,提出对慢性湿性咳嗽患儿及时甄别出PBB,需要依靠全面可靠的问诊、详细的体格检查及有关辅助检查.对婴幼儿,特别是有持续性慢性湿性咳嗽临床表现、肺部及胸部影像学无特异性改变的患儿,结合有关PBB的临床或/和病原学诊断标准,在排除上呼吸道咳嗽综合征、咳嗽变异性哮喘、特定病原体的呼吸道感染、呼吸道异物等原因引起的慢性湿性咳嗽后,做出PBB的诊断.并注意临床的观察和随访.%Chronic cough is a very common symptom of children presenting to pediatric practitioners,moreover,chronic wet cough is especially troublesome for children's health.Since protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in children,it is of great importance to timely identify PBB from children with chronic cough.Now,the clinical features and diagnostic clues of PBB,as well as the diagnostic criteria of PBB based on microbiology are introduced;it is also proposed that comprehensive and reliable consultation,detailed physical examination and related laboratory tests are needed when identifying PBB out of children with chronic wet cough.For infants and young children,in particular those with persistent wet cough and without any specific changes of chest radiography and other specific cough pointers (eg,upper airway cough syndrom,cough type asthma,respiratory tract infection with specific pathogen,foreign body),the diagnosis of PBB should be taken into consideration and clinical observation and follow-up are needed to reevaluate.