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哮吼的药物治疗及支持治疗

Author
Charles R Woods, MD, MS
Section Editors
Sheldon L Kaplan, MD
Anna H Messner, MD
Deputy Editor
Carrie Armsby, MD, MPH
Translators
王琳, 主治医师

引言

哮吼(喉气管炎)是一种以吸气性喘鸣、犬吠样咳嗽和声嘶为特征的呼吸系统疾病。一般发生于6月龄至3岁的儿童，最常见的病因是副流感病毒感染。 (参见“哮吼的临床特征、评估和诊断”)

自20世纪80年代以来哮吼的治疗发生了很大变化。糖皮质激素，以及肾上腺素雾化，已经成为治疗的基石。大量临床证据支持这些干预的有效性[1-5]。美国1979-1982年到1994-1997年哮吼儿童的年住院率降低也证明了这一点：对于1岁以下儿童，住院率从每1000例中2.8例降至2.1例；对于1-4岁儿童，住院率从每1000例中1.8例降至1.2例[6]。

哮吼的治疗包括一系列药物及非药物治疗。可完全在家中治疗，也可在门诊、急诊室(emergency department, ED)或住院治疗。本文将总结哮吼的支持治疗和药物治疗。哮吼的临床特征和评估及治疗方法将单独讨论。 (参见“哮吼的临床特征、评估和诊断”和“哮吼的治疗方法”)

糖皮质激素

糖皮质激素能为轻、中和重度哮吼提供持久且有效的治疗[3,7-9]。其抗炎作用被认为可以减轻哮吼患儿的喉黏膜水肿。在给药后6小时内通常可见改善，但很少有显著改善[7,10]。

不同剂量和不同给药途径的糖皮质激素治疗可以改善哮吼评分，减少计划外的就诊、缩短急诊室或医院停留时间，以及减少肾上腺素的使用[7]。现有的糖皮质激素中，地塞米松最常使用、价格最低廉，作用时间最长，并且给药最方便。

                        

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Literature review current through: 2017-07 . | This topic last updated: 2016-08-02.
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