儿童咽喉痛的评估
- Author
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Section Editors
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
引言
咽喉痛是指位于咽部或其周围解剖结构的任何疼痛性感觉。幼儿鉴别和描述症状的能力是不同的，医生必须认真注意患儿和看护人员，以便弄清主诉的确切性质。
咽喉痛可能是并不直接影响咽部的疾病的症状。偶然情况下，由于食管区域的疾病引起吞咽障碍，或由于神经肌肉疾病引起吞咽困难的患儿，可能描述这些感觉为咽喉痛，或他们的症状可能被看护人员解释为咽喉痛。
本专题将总结可引起咽喉痛症状的情况。讨论内容将包括病史和体格检查的有关特点，及常见疾病和危及生命疾病的诊断流程。对感染性咽炎儿童的诊断方法在别处进行更加详细讨论。 (参见“儿童及青少年急性感染性咽炎的诊断方法”)
病因
致命的疾病
会厌炎 — 会厌炎是一种相当受重视的致命性上呼吸道感染疾病，其发病率自从引入抗B型流感嗜血杆菌疫苗以来，已显著降低[1]。该病表现为中毒性病容、高热、喘鸣和流涎[2,3]。咽喉痛在许多病例中出现，但极少单独为主诉。 (参见“会厌炎(声门上炎)：临床特征和诊断”)
咽后脓肿 — 咽后脓肿可引起咽喉痛，通常发生于年龄小于4岁的儿童[4]。其他主诉包括颈部疼痛和发热。可能存在吞咽困难和呼吸窘迫。脓肿的位置靠后使之难以在体格检查时被肉眼发现。通常需要影像学检查以确定诊断。 (参见“儿童咽后感染”)
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