Hussain M Z, Ishrat S, Salehuddin M, Mahmood M, Islam M T
Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh.
Mymensingh Med J. 2011 Jan;20(1):165-70.
Chest pain is a common symptom for children and adolescents. It is the second most frequent complaint leading to referral to paediatric cardiologist, murmurs being the largest. The most common cause of chest pain prompting a child to visit a physician is idiopathic chest pain (21-59%). Other disorders are pulmonary (12-24%), psychologic (17-19%), musculoskeletal (7-16%), gastrointestinal (5-7%), cardiac (1-4%) and miscellaneous (2-4%). Most children with chest pain have normal physical findings. Careful physical examination can reveal important clues and save much unnecessary investigations. When an organic cause is found for the pain then specific treatment is commenced. Depending on the circumstances, a therapeutic trial may be warranted, for example use of an inhaled bronchodilator 15-20 minutes before exercise for suspected exercise induced asthma, use of adequate anti-reflux medication for gastro-oesophageal reflux disease or non-steroidal anti-inflammatory medication for musculoskeletal pain. Where an organic cause is not considered to be present, explanation and reassurance can reduce anxiety and decrease the severity of the symptoms. This article specifically deals with problems of chest pain in children and approach to such problems in the form of relevant investigations and management.
胸痛是儿童和青少年的常见症状。它是导致转诊至儿科心脏病专家的第二常见主诉，杂音是最常见的主诉。促使儿童就医的胸痛最常见原因是特发性胸痛（21% - 59%）。其他疾病包括肺部疾病（12% - 24%）、心理因素（17% - 19%）、肌肉骨骼疾病（7% - 16%）、胃肠道疾病（5% - 7%）、心脏疾病（1% - 4%）以及其他杂症（2% - 4%）。大多数胸痛儿童的体格检查结果正常。仔细的体格检查可以揭示重要线索，避免许多不必要的检查。当发现疼痛的器质性病因时，便开始进行特定治疗。根据具体情况，可能需要进行治疗性试验，例如对于疑似运动诱发性哮喘，在运动前15 - 20分钟使用吸入性支气管扩张剂；对于胃食管反流病，使用足够的抗反流药物；对于肌肉骨骼疼痛，使用非甾体类抗炎药物。如果不认为存在器质性病因，给予解释和安慰可以减轻焦虑并缓解症状的严重程度。本文专门探讨儿童胸痛问题以及通过相关检查和管理来处理此类问题的方法。
