Vorwerk C, Coats T J
Emergency Department Academic Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
Emerg Med J. 2008 Sep;25(9):547-50. doi: 10.1136/emj.2007.052878.
To determine the effect of helium-oxygen inhalation on relieving symptoms and distress in children with croup as measured by the croup score, and to identify areas of uncertainty for future research.
Systematic review of prospective randomised and non-randomised controlled trials of children with the clinical diagnosis of croup, comparing the effect of helium-oxygen mixtures with placebo or any active treatment. Outcome measures were change in croup score, physiological parameters, hospital admission rates, need for intubation and adverse events. All records as identified by a systematic search strategy were assessed independently by two reviewers.
Two trials were identified for inclusion assessing the effect of helium-oxygen inhalation in children with croup in an emergency department. In one trial the control group received humidified oxygen and in the other nebulised epinephrine. An improvement in the mean croup score over time was seen in the control and intervention groups of both trials, with no significant difference between the groups. Significant methodological and clinical heterogeneity in the design of the trials precluded a meaningful meta-analysis.
At present there is no evidence to support the use of helium-oxygen therapy in children with croup. Methodologically well-designed and adequately powered randomised controlled trials are needed to determine whether helium-oxygen inhalation as part of the initial treatment in croup alters outcome.
通过哮吼评分来确定氦氧混合气吸入对缓解哮吼患儿症状及痛苦的效果，并确定未来研究中存在不确定性的领域。
对临床诊断为哮吼的儿童进行前瞻性随机和非随机对照试验的系统评价，比较氦氧混合气与安慰剂或任何积极治疗的效果。结局指标包括哮吼评分的变化、生理参数、住院率、插管需求及不良事件。由系统检索策略确定的所有记录由两名评价者独立评估。
确定两项试验纳入评价急诊科氦氧混合气吸入对哮吼患儿的效果。一项试验中对照组接受湿化氧气，另一项试验中对照组接受雾化肾上腺素。两项试验的对照组和干预组哮吼平均评分均随时间改善，组间无显著差异。试验设计中存在显著的方法学和临床异质性，无法进行有意义的荟萃分析。
目前尚无证据支持在哮吼患儿中使用氦氧治疗。需要设计方法学严谨且样本量充足的随机对照试验，以确定氦氧混合气吸入作为哮吼初始治疗的一部分是否会改变结局。
