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幼儿复发性病毒诱发性喘鸣的治疗

Author
Sujani Kakumanu, MD
Section Editors
Gregory Redding, MD
Robert A Wood, MD
Deputy Editor
Elizabeth TePas, MD, MS
Translators
车大钿, 副主任医师

引言

儿童期早期喘鸣发作是常见的异质性疾病，具有明显病况。对于存在多种诱因的复发性喘鸣儿童和主要诱因是病毒感染的复发性喘鸣发作的儿童，公认病毒是儿童期早期喘鸣的常见诱因。事实上，一项出生队列研究针对发生哮喘风险增加儿童，发现90%的喘鸣性疾病都有病毒性病因[1]。儿童期早期喘鸣包括许多临床表型，对治疗的反应也各不相同。对于部分患者，开始进行或逐步增强哮喘治疗能够有效控制病毒诱发性喘鸣症状。然而，对照研究中就该疗法得出的证据没有决定性意义，对存在间歇性症状的患者来说尤其如此。

尚不确定婴儿和学龄前儿童病毒诱发性喘鸣急性发作的最佳疗法[2]。对这些年幼人群进行治疗尝试因不能预测临床表型而受到限制，如有些儿童的症状会年龄增长而消失、有些儿童以后会发展为哮喘，还有些儿童存在毛细支气管炎(一般不推荐使用糖皮质激素治疗毛细支气管炎)。 (参见“婴儿及儿童毛细支气管炎的治疗、结局及预防”)

本专题将总结复发性病毒诱发性喘鸣幼儿的治疗，这是指1年至少出现3-4次喘鸣发作[3]。婴儿毛细支气管炎的治疗，以及儿童和成人的病毒诱发性哮喘发作，均将单独讨论。呼吸道病毒感染引起喘鸣和哮喘发作的机制，以及病毒感染对哮喘发生和持续存在的影响也将单独讨论。 (参见“婴儿及儿童毛细支气管炎的治疗、结局及预防”和“哮喘管理概述”和“病毒诱导的喘鸣和哮喘：概述”)

间歇性治疗

病毒诱发性喘鸣是一种异质性的疾病，对治疗的反应可能因人而异。吸入性短效β2受体激动剂是常用于缓解症状的药物。目前正在研究将高渗盐水(hypertonic saline, HS)与一种支气管扩张剂联合用于治疗急性症状。已在需要额外治疗的幼儿中研究了使用吸入性和全身性糖皮质激素及白三烯受体拮抗剂(leukotriene-receptor antagonist, LTRA)防治病毒诱发性喘鸣急性发作。哮喘的治疗(治疗急性发作和预防症状)将单独详细讨论。 (参见“12岁以下儿童哮喘：急性症状的急救治疗”和“12岁以下儿童的哮喘：使用控制药物治疗持续哮喘”和“儿童哮喘急性发作的急诊科治疗”和“儿童哮喘急性发作：住院患者处理”和“儿童重度哮喘急性发作：重症监护病房治疗”)

吸入性短效β2-受体激动剂 — 吸入性支气管扩张剂通常是病毒诱发性喘鸣的一线治疗，对于有症状患者也是有效的补救治疗，特别是确诊哮喘的儿童(表 1)。然而对于毛细支气管患儿，尚未发现吸入性短效支气管扩张剂可改善临床结局、降低住院率和减少住院时间[4]。此外，一项系统评价和meta分析显示，急性咳嗽或支气管炎儿童使用β受体激动剂没有获益，不过该分析仅限于2项儿童试验[5]。 (参见“12岁以下儿童哮喘：急性症状的急救治疗”和“儿童哮喘急性发作的急诊科治疗”，关于‘给药剂量和给药方式’一节和“儿童哮喘急性发作的急诊科治疗”，关于‘治疗概述’一节和“婴儿及儿童毛细支气管炎的治疗、结局及预防”，关于‘支气管扩张剂’一节)

          

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Literature review current through: 2017-07 . | This topic last updated: 2016-03-30.
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