González de Dios J, Ochoa Sangrador C
Departamento de Pediatría, Hospital de Torrevieja, Universidad Miguel Hernández, Alicante, España.
An Pediatr (Barc). 2010 Apr;72(4):285.e1-285.e42. doi: 10.1016/j.anpedi.2009.12.010. Epub 2010 Mar 26.
A review of the evidence on treatment of acute bronchiolitis is presented. There is sufficient evidence on the lack of effectiveness of most interventions tested in bronchiolitis. Apart from oxygen therapy, fluid therapy, aspiration of secretions and ventilation support, few treatment options will be beneficial. There are doubts about the efficacy of inhaled bronchodilators (salbutamol or adrenaline), with or without hypertonic saline solution, suggesting that these options should be selectively used as therapeutic trials in moderate-severe bronchiolitis. Heliox and non-invasive ventilation techniques, methylxanthine could be used in cases with respiratory failure, in patients with apnea, and surfactant and inhaled ribavirin in intubated critically ill patients. The available evidence does not recommend the use of oral salbutamol, subcutaneous adrenaline, anticholinergic drugs, inhaled or systemic corticosteroids, antibiotics, aerosolized o intravenous immunoglobulin, respiratory physiotherapy and others (nitric oxide, recombinant human deoxyribonuclease, recombinant interferon, nebulised furosemide and so on).
本文对急性细支气管炎的治疗证据进行了综述。有充分证据表明，在细支气管炎中测试的大多数干预措施缺乏有效性。除了氧疗、液体疗法、分泌物抽吸和通气支持外，很少有治疗方法会有益处。吸入支气管扩张剂（沙丁胺醇或肾上腺素）无论是否联合高渗盐溶液的疗效存疑，这表明这些方法应作为中重度细支气管炎的治疗试验选择性使用。氦氧混合气和无创通气技术、甲基黄嘌呤可用于呼吸衰竭患者、呼吸暂停患者，表面活性剂和吸入利巴韦林可用于插管的危重症患者。现有证据不推荐使用口服沙丁胺醇、皮下注射肾上腺素、抗胆碱能药物、吸入或全身性皮质类固醇、抗生素、雾化或静脉注射免疫球蛋白、呼吸物理治疗及其他（一氧化氮、重组人脱氧核糖核酸酶、重组干扰素、雾化速尿等）。
