作　　者： (王晓颖）; (米荣）; (伏瑾）; (李莉）; (崔小岱）; (张宝元）; (朱虹）; (何君）; (季岩伟）;

机构地区： 首都儿科研究所附属儿童医院新生儿科,北京100020

出　　处： 《中华围产医学杂志》 2017年第8期583-588,共6页

摘　　要： 目的总结3月龄以下婴儿百日咳的临床特征。 方法选择2011年1月1日至2015年12月31日首都儿科研究所附属儿童医院收治的迁延性咳嗽、痉挛性咳嗽或不明原因青紫、窒息、呼吸暂停的3月龄以下患儿，分别采用多重聚合酶链反应法及酶联免疫吸附试验法检测博德特百日咳杆菌及百日咳毒素抗体，对确诊病例的临床特征、合并症、重症百日咳、治疗、转归进行分析。 结果5年间总计入组患儿202例，博德特百日咳杆菌检测阳性59例（29.2%），其中男37例，女22例；起病年龄生后13~85 d；住院时间7~21 d；12例患儿有家庭内慢性咳嗽患者接触史；百日咳春夏季节发病46例（78.0%），秋冬季节发病13例（22.0%）；痉挛性咳嗽表现41例次（69.5%），咳嗽后口唇青紫36例次（61.0%），咳嗽后呕吐39例次（66.1%），结膜出血33例次（55.9%），百日咳特征性表现咳嗽吸气末鸡鸣样吼声仅6例次（10.2%）；49例（83.1%）淋巴细胞计数≥10×109/L。重症百日咳患儿28例（47.5%），其中合并咳嗽后呼吸暂停、心率下降23例（39.0%）；合并呼吸衰竭、心力衰竭18例（30.5%）；合并百日咳脑病表现5例（8.5%）；重度白细胞增高（均≥60×109/L）4例（6.8%）；24例给予呼吸支持治疗，其中6例有创呼吸机辅助通气治疗，18例无创呼吸机辅助通气治疗。1例患儿死亡，其余好转出院。 结论博德特百日咳杆菌感染是3月龄以下婴儿迁延性咳嗽的重要致病因素，婴儿百日咳症状不典型，重症发生率高。需要早期识别，及时治疗。 ObjectiveTo study the epidemiological and clinical characteristics of pertussis in infants younger than three months. MethodsInfants younger than three months were enrolled from January 1, 2011 to December 31, 2015 with one or more of the following symptoms： persistent cough, spasmic cough, cyanosis of unknown causes, asphyxia and apnea. Multiplex polymerase chain reaction（PCR） assay was performed to identifyBordetella pertussisand enzyme-linked immunosorbent assay was used to detect antibody to pertussis toxin. Clinical features, complications, treatments and prognosis of the infants confirmed with pertussis were analyzed.ResultsAltogether 202 cases were enrolled in the five years, and 59 （29.2%） of which were positive for pertussis confirmed by multiplex PCR. Among the 59 cases, 37 were boys and 22 were girls. The youngest baby was 13 days and the oldest one was 85 days. Length of stay ranged from 7 to 21 days. Twelve cases had a contact history with family members having chronic cough. Symptoms occurred in spring or summer in 46 cases （78.0%）, and in autumn or winter in 13 （22.0%） cases. Symptoms of spasmic cough, cyanosis after coughing, vomiting after coughing and conjunctival hemorrhage were respectively found in 41 （69.5%）, 36 （61.0%）, 39 （66.1%） and 33 （55.9%） cases, while only six （10.2%） presented with inspiratory whooping sound on coughing. Forty-nine cases （83.1%） showed increased lymphocyte count （≥10×109/L）. Twenty-eight cases （47.5%） developed severe pertussis. Complications including apnea and bradycardia after coughing, respiratory failure and heart failure, pertussis encephalopathy as well as highly increased leucocyte count （≥60×109/L） occurred in 23 （39.0%）, 18 （30.5%）, five （8.5%） and four （6.8%） cases, respectively. Twenty-four cases with severe pertussis required respiratory support, of which six received invasive ventilation and 18 received non-invasive ventilation. Fifty-eight infants were recovered and discharge

关 键 词： 百日咳 婴儿 咳嗽 发病率