Johnson David Wyatt
Department of Pediatrics, University of Calgary, Calgary, Canada.
BMJ Clin Evid. 2014 Sep 29;2014:0321.
Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. It leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children per year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by parainfluenza virus. Symptoms usually resolve within 48 hours, but severe upper airway obstruction can, rarely, lead to respiratory failure and arrest.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in children with mild croup and moderate to severe croup? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 19 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids (dexamethasone, intramuscular and oral), nebulised budesonide, oral prednisolone, heliox, humidification, and nebulised adrenaline (racemate and L-adrenaline [ephinephrine]).
哮吼的特征是突然发作，最常见于夜间，伴有犬吠样咳嗽、吸气性喘鸣、声音嘶哑以及由于上呼吸道梗阻导致的呼吸窘迫。它会导致上呼吸道梗阻的体征，必须与急性会厌炎、细菌性气管炎或吸入异物相鉴别。哮吼每年影响约3%的儿童，通常在6个月至3岁之间，75%的感染由副流感病毒引起。症状通常在48小时内缓解，但严重的上呼吸道梗阻很少会导致呼吸衰竭和心跳骤停。
我们进行了一项系统评价，旨在回答以下临床问题：治疗对轻度哮吼和中重度哮吼患儿有何影响？我们检索了：截至2013年11月的Medline、Embase、Cochrane图书馆及其他重要数据库（临床证据综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及医疗保健产品监管局（MHRA）等相关组织的危害警示。
我们发现19项研究符合我们的纳入标准。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们提供了以下干预措施的有效性和安全性相关信息：皮质类固醇（地塞米松，肌肉注射和口服）、雾化布地奈德、口服泼尼松龙、氦氧混合气、湿化以及雾化肾上腺素（消旋体和L-肾上腺素[肾上腺素]）。
