标准·方案·指南
ENGLISH ABSTRACT
中国儿童咳嗽诊断与治疗临床实践指南(2023基层版)
中华医学会儿科学分会临床药理学组
国家儿童健康与疾病临床医学研究中心
中华医学会儿科学分会呼吸学组
中国医师协会儿科医师分会儿童呼吸专业委员会
中国妇幼保健协会儿童变态反应专业委员会呼吸学组
中华儿科杂志编辑委员会
作者及单位信息
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DOI: 10.3760/cma.j.cn112140-20240112-00046
Clinical practice guidelines for the diagnosis and management of children with cough in China (version 2023 for primary care)
The Subspecialty Group of Pharmacology, the Society of Pediatrics, Chinese Medical Association
National Clinical Research Center for Child Health and Disorders
the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association
the Children′s Respiratory Professional Committee, the Society of Pediatrics of Chinese Medical Doctor Association
Respiratory Group, Professional Committee of Child Allergology, China Maternal and Child Health Association
the Editorial Board, Chinese Journal of Pediatrics
Liu Enmei
Lu Quan
Authors Info & Affiliations
The Subspecialty Group of Pharmacology, the Society of Pediatrics, Chinese Medical Association
National Clinical Research Center for Child Health and Disorders
the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association
the Children′s Respiratory Professional Committee, the Society of Pediatrics of Chinese Medical Doctor Association
Respiratory Group, Professional Committee of Child Allergology, China Maternal and Child Health Association
the Editorial Board, Chinese Journal of Pediatrics
Liu Enmei
Department of Respiratory Medicine, Children′s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing 400014, China
Lu Quan
Department of Pulmonology, Shanghai Children′s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
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DOI: 10.3760/cma.j.cn112140-20240112-00046
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摘要

咳嗽是儿童呼吸系统疾病的常见症状和就诊原因。我国基层医疗机构限于诊疗技术和条件,对儿童咳嗽诊断和治疗等方面的认知普遍不全相同,且具有一定的特殊性。由此,中华医学会儿科学分会临床药理学组等联合制订“中国儿童咳嗽诊断与治疗临床实践指南(2023基层版)”,通过前期调研,充分征询基层医生的意见,针对儿童咳嗽评估、诊断、用药、转诊和健康教育等方面9个迫切关注的重要问题,形成17条循证推荐意见和建议,旨在指导基层医务工作者规范、科学地诊治儿童咳嗽,同步提升对儿童咳嗽的管理水平。

引用本文

中华医学会儿科学分会临床药理学组,国家儿童健康与疾病临床医学研究中心,中华医学会儿科学分会呼吸学组,等. 中国儿童咳嗽诊断与治疗临床实践指南(2023基层版)[J]. 中华儿科杂志,2024,62(04):292-302.

DOI:10.3760/cma.j.cn112140-20240112-00046

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咳嗽是呼吸道对各种刺激的保护性生理反射,但剧烈或长期咳嗽不仅影响患儿的生活质量,也会给家庭和社会带来相当的负担 1。无论在基层医疗机构还是上级医院呼吸专科,咳嗽均是儿童就诊的常见原因 2,据估计我国儿童慢性咳嗽患病率高于成人,约为7.67% 3。中华儿科杂志于2008、2013年分别推出了两版儿童慢性咳嗽诊治指南,2021年发表了基于循证方法制订的“中国儿童咳嗽诊断与治疗临床实践指南(2021版)”(以下简称“2021专业版指南”) 4 , 5 , 6,紧接又适时推出了“中国儿童咳嗽指南(2021患者版)” 7。多部指南的推广和应用有效提升了儿科医生对咳嗽相关疾病的诊疗水平,也促进了家长对咳嗽症状的认知和对咳嗽患儿的合理照护与共同决策,促成了医患沟通诊治疾病的新模式。但是,我国幅员辽阔,医疗技术资源分布并不均衡,基层医生对咳嗽关注的问题与上级医院不全相同,为解决这一现实矛盾,进一步提升基层医疗机构对儿童咳嗽的管理水平,中华医学会儿科学分会临床药理学组、国家儿童健康与疾病临床医学研究中心、中华医学会儿科学分会呼吸学组、中国医师协会儿科医师分会儿童呼吸专业委员会、中国妇幼保健协会儿童变态反应专委会呼吸学组、中华儿科杂志编辑委员会历时1年联合制订“中国儿童咳嗽诊断与治疗临床实践指南(2023基层版)”(以下简称“本指南”)。本指南由兰州大学健康数据科学研究院、重庆医科大学附属儿童医院儿童卓越证据与指南协同创新实验室提供方法学指导,遵循“2021专业版指南”的制订方法和标准进行,侧重提出并回答基层临床实践中儿童咳嗽诊治所存在的突出问题,给出循证推荐意见和建议及其等级,由此进一步扩大指南的受益面,并同步规范和优化基层医疗机构的临床诊疗水平。本指南适用于18岁以下、有咳嗽症状而就诊于《中华人民共和国基本医疗卫生与健康促进法》(2019年12月28日通过)定义为基层的医疗机构及部分二级医疗机构。
本指南是基于循证方法制订的儿童咳嗽基层指南,从“2021专业版指南”到“中国儿童咳嗽指南(2021患者版)”再到本指南,围绕着儿童咳嗽这个症状,从不同角度反复陈述,本意就是坚持指南的科学性、透明性和适用性,在不同层面上强调对咳嗽规范化诊治的重要性,力求能上下同步并医患沟通。本指南不是“2021专业版指南”的全面更新,而是在其基础上的一个全新尝试和补充,让指南更走近基层医疗机构。有别于“2021专业版指南”之一是证据分级引入了“良好实践声明(good practice statement,GPS)”这一概念,对于缺乏直接证据的重要临床问题,采纳并推荐基于来自专家共识的声明,指导基层医生在实践中参考。另外是在关于用药的推荐意见方面,从药学角度介绍了药物的特点、适应证和不良反应,较“2021专业版指南”增加了具体可用药物的条件,由此增添了实用性。此外,还新增了急危重症的识别、咳嗽可能引起的呼吸系统外征象,细化了基层转诊的指征和健康教育的内容等,让本指南更适用于指导基层医生的临床实践工作。
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备注信息
A
刘恩梅,国家儿童健康与疾病临床医学研究中心 重庆医科大学附属儿童医院呼吸科,重庆 400014,Email: mocdef.6ab21681uilme
B
陆权,上海市儿童医院 上海交通大学医学院附属儿童医院呼吸科,上海 200062,Email: mocdef.aabnis.pivhs-nauqul
C
中华医学会儿科学分会临床药理学组, 国家儿童健康与疾病临床医学研究中心, 中华医学会儿科学分会呼吸学组, 等. 中国儿童咳嗽诊断与治疗临床实践指南(2023基层版)[J]. 中华儿科杂志, 2024, 62(4): 292-302. DOI: 10.3760/cma.j.cn112140-20240112-00046.
D
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