以发绀为表现的婴幼儿咽喉反流疾病临床分析

来源 :中国小儿急救医学 | 被引量 : 0次 | 上传用户:xf198699
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目的:总结以发绀为主要表现的婴幼儿咽喉反流疾病(laryngopharyngeal reflux disease,LPRD)的临床特点,提高对该病的认识,避免误诊漏诊。方法:回顾性分析2015年9月至2018年10月在深圳市儿童医院确诊为LPRD患儿的临床资料。结果:5例患儿均以发绀为主要表现,2例为食管闭锁术后,病程从3 d~4个月不等;4例合并喉软化,1例合并重度气管软化,1例合并食管狭窄;5例均有声带及杓间区黏膜水肿;24 h咽喉部pH值监测Ryan指数立位为65.92~1 444.5,卧位3.73~431.44;3例根据病原学结果给予红霉素、头孢曲松抗感染;2例加用多潘立酮口服,3例加用奥美拉唑口服;1例坚持服药8周,症状缓解,复查Ryan指数正常;3例服用4周药物,症状减轻,家属自行停药;1例在服药期间仍出现发绀,气管镜检查提示气管重度软化,给予气管支架植入,症状缓解。结论:LPRD与儿童呼吸、消化系统疾病密切相关,当患儿出现难以解释的呼吸道及消化道症状时应考虑到LPRD,尽早完善喉镜和Dx-pH检测,避免漏诊。“,”Objective:To analyze the clinical characteristics of infantile laryngopharyngeal reflux diseases(LPRD) with cyanosis as the main manifestation, improve diagnosis of the disease and avoid missed diagnosis.Methods:Clinical data of children diagnosed with LPRD at Shenzhen Children′s Hospital from September 2015 to October 2018 were retrospectively analyzed.Results:Cyanosis was the predominant symptom in all 5 cases.The course ranged from 3 days to 4 months.Laryngomalacia was observed in 4 cases.Two patients were treated with esophageal atresia, 1 with esophageal stenosis and 1 with severe tracheomalacia.All 5 cases had vocal cord and arytenoid mucosa edema.The Ryan index was 65.92-1 444.5 in the upright position and 3.73-431.44 in the supine position.Three cases were treated with erythromycin and ceftriaxone according to the etiology.Two cases were treated with motilium at the same time, and 3 cases were with omeprazole oral.One case was recovered after 8 weeks and the Ryan index became normal.Symptoms were alleviated in 3 patients after 4 weeks, drugs were stopped by parents.One case still had cyanosis during medication, the symptoms were significantly relieved after tracheal stent implantation.Conclusion:LPRD is closely related to children′s respiratory and digestive system diseases.LPRD should be taken into account when children show unexplained clinical symptoms of respiratory and digestive system, and laryngoscopy and DX-pH detection should be performed as soon as possible to avoid missed diagnosis.
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