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婴儿和儿童喘鸣的评估方法

Author
Khoulood Fakhoury, MD
Section Editor
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS
Translators
刘恩梅, 主任医师，教授

引言

喘鸣是婴儿和儿童呼吸系统疾病的一种常见主诉症状。美国1988年至1994年的一项全国性调查显示，在2-3岁儿童中喘鸣的患病率为26%，在9-11岁儿童中的患病率为13%[1]。在3岁之前，1/3的儿童至少患过1次有急性喘鸣的疾病[2,3]。喘鸣可能是一种良性的自限性疾病，也可能是严重呼吸系统疾病的主诉症状[4]。临床医生的职责是尽可能快速有效地作出最可能的诊断，以便在必要时可开始给予治疗，并解除患儿家长的担忧。

无论发病年龄、特应性疾病的证据、诱发原因或发作频率如何，儿童复发性喘鸣最可能的诊断是哮喘[5]。然而，在婴儿期和儿童期中，其他疾病也可表现为喘鸣，而哮喘患者可能不出现喘鸣。喘鸣的鉴别诊断包括多种先天性和获得性疾病(表 1)。

通常能根据临床病史及体格检查作出准确诊断。然而，恰当使用放射影像学检查、肺功能测定、支气管镜、汗液氯化物浓度测定和选择性实验室检查也有助于确定喘鸣的潜在病因[5,6]。喘鸣患儿的初始评估旨在排除其他诊断，排除后如果疑诊为哮喘，可给予支气管扩张剂进行尝试性治疗。

儿童期喘鸣的诊断方法见此专题。复发性喘鸣表型的概述、儿童非哮喘性喘鸣病因的总结，以及哮喘的诊断和治疗参见其他专题。病毒诱发的喘鸣及对急性呼吸窘迫患儿的紧急评估也将单独讨论。 (参见“喘鸣表型和年幼儿童哮喘的预测”和“12岁以下儿童的哮喘：初始评估和诊断”和“12岁以下儿童的哮喘：使用控制药物治疗持续哮喘”和“病毒诱导的喘鸣和哮喘：概述”和“幼儿复发性病毒诱发性喘鸣的治疗”和“儿童急性呼吸窘迫的紧急评估和初始稳定措施”)

哮鸣音的定义及生理学

哮鸣音是在胸部听诊时听到的一种连续性音乐性声响，持续时间超过250毫秒[7]。它是由狭窄到几乎互相接触的气道的两侧壁的振动产生的[8]。哮鸣音可以呈高音调也可以呈低音调，由单个或多个音符组成，发生于吸气或呼气时。哮鸣音可起源于近端传导气道中任意粗细的气道。除气道变窄或受压外，还需要足够的气流才能使气道振动，产生哮鸣音。因此，在急性哮喘患者中，未闻及哮鸣音可能是一个不祥的发现，提示即将发生呼吸衰竭。

            

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Literature review current through: 2017-07 . | This topic last updated: 2017-07-10.
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