Eber Ernst
Respiratory and Allergic Disease Division, Pediatric Department, Medical University of Graz, Austria.
Open Microbiol J. 2011;5:159-64. doi: 10.2174/1874285801105010159. Epub 2011 Dec 30.
Acute viral bronchiolitis represents the most common lower respiratory tract infection in infants and young children and is associated with substantial morbidity and mortality. Respiratory syncytial virus is the most frequently identified virus, but many other viruses may also cause acute bronchiolitis. There is no common definition of acute viral bronchiolitis used internationally, and this may explain part of the confusion in the literature. Most children with bronchiolitis have a self limiting mild disease and can be safely managed at home with careful attention to feeding and respiratory status. Criteria for referral and admission vary between hospitals as do clinical practice in the management of acute viral bronchiolitis, and there is confusion and lack of evidence over the best treatment for this condition. Supportive care, including administration of oxygen and fluids, is the cornerstone of current treatment. The majority of infants and children with bronchiolitis do not require specific measures. Bronchodilators should not be routinely used in the management of acute viral bronchiolitis, but may be effective in some patients. Most of the commonly used management modalities have not been shown to have a clear beneficial effect on the course of the disease. For example, inhaled and systemic corticosteroids, leukotriene receptor antagonists, immunoglobulins and monoclonal antibodies, antibiotics, antiviral therapy, and chest physiotherapy should not be used routinely in the management of bronchiolitis. The potential effect of hypertonic saline on the course of the acute disease is promising, but further studies are required. In critically ill children with bronchiolitis, today there is little justification for the use of surfactant and heliox. Nasal continuous positive airway pressure may be beneficial in children with severe bronchiolitis but a large trial is needed to determine its value. Finally, very little is known on the effect of the various interventions on the development of post-bronchiolitic wheeze.
急性病毒性细支气管炎是婴幼儿最常见的下呼吸道感染，与较高的发病率和死亡率相关。呼吸道合胞病毒是最常检测到的病毒，但许多其他病毒也可能导致急性细支气管炎。国际上对于急性病毒性细支气管炎尚无通用定义，这可能是文献中存在部分混淆的原因之一。大多数细支气管炎患儿病情为自限性且较轻，在家中通过密切关注喂养和呼吸状况可安全管理。不同医院的转诊和住院标准以及急性病毒性细支气管炎的临床管理实践各不相同，对于该病的最佳治疗方法存在困惑且缺乏证据。支持性治疗，包括给氧和补液，是当前治疗的基石。大多数细支气管炎婴幼儿不需要特殊措施。支气管扩张剂不应常规用于急性病毒性细支气管炎的治疗，但可能对某些患者有效。大多数常用的管理方式尚未显示对疾病进程有明确的有益效果。例如，吸入性和全身性皮质类固醇、白三烯受体拮抗剂、免疫球蛋白和单克隆抗体、抗生素、抗病毒治疗以及胸部物理治疗不应常规用于细支气管炎的治疗。高渗盐水对急性疾病进程可能有良好效果，但需要进一步研究。对于患有细支气管炎的重症患儿，目前使用表面活性剂和氦氧混合气几乎没有依据。鼻持续气道正压通气可能对重症细支气管炎患儿有益，但需要大型试验来确定其价值。最后，对于各种干预措施对细支气管炎后喘息发生发展的影响知之甚少。
