Pinto Jamie M, Schairer Janet L, Petrova Anna
Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ, USA.
Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ, USA.
Pediatr Neonatol. 2016 Apr;57(2):140-4. doi: 10.1016/j.pedneo.2015.04.014. Epub 2015 Sep 14.
Acute bronchiolitis is one of the main respiratory emergencies in young children. Although supportive therapy is recommended, substantial inconsistency in the clinical usage of inhaled treatments has been reported. In the present study, we evaluated the association between different types of nebulized therapies in clinical practice and the length of stay (LOS) of young children hospitalized with nonsevere bronchiolitis.
Medical records of 195 patients with bronchiolitis, without evidence of pneumonia or congenital/chronic respiratory conditions, were stratified with respect to the type of inhalation therapy received: nebulized albuterol (Group 1, n = 53), nebulized albuterol with 3% saline (Group 2, n = 38), nebulized 3% saline alone (Group 3, n = 33), or no inhaled treatment (Group 4, n = 71). Duration of hospital stay was reported with respect to the type of inhalation therapy received after controlling for variability in patient age (months), oxygen saturation, respiratory score, and use of other treatments (antibiotics, oxygen supplementation, and/or corticosteroids). LOS is presented in terms of mean and 95% confidence interval (95% CI).
The groups were similar except for differences in the mean level of oxygen saturation, respiratory score, and corticosteroid use. Children in Group 4 had the lowest mean respiratory score due to a lesser prevalence of wheezing and/or retractions than in other groups. The LOS for children in Groups 1 and 4 was shorter (43.2 hours, 95% CI 34.9-51.3, and 44.1 hours, 95% CI 37.3-51.0, respectively) than in Groups 2 and 3 (72 hours, 95% CI 62.1-81.6, and 65.1 hours, 95% CI 54.7-75.6, respectively) (p < 0.02). The mean LOS in each group did not change significantly after adjustment for covariants.
Prolonged hospitalization of children younger than 2 years with acute, nonsevere bronchiolitis is associated with administration of nebulized 3% saline, independent of age, clinical presentation of disease, or inclusion of other treatments in their management.
急性细支气管炎是幼儿主要的呼吸急症之一。尽管推荐采用支持性治疗，但据报道吸入治疗的临床应用存在很大差异。在本研究中，我们评估了临床实践中不同类型的雾化治疗与非重症细支气管炎住院幼儿住院时间（LOS）之间的关联。
195例无肺炎或先天性/慢性呼吸疾病证据的细支气管炎患者的病历，根据接受的吸入治疗类型进行分层：雾化沙丁胺醇（第1组，n = 53）、雾化沙丁胺醇加3%盐水（第2组，n = 38）、单独雾化3%盐水（第3组，n = 33）或未进行吸入治疗（第4组，n = 71）。在控制患者年龄（月）、血氧饱和度、呼吸评分以及其他治疗（抗生素、吸氧和/或皮质类固醇）的变异性后，报告住院时间与接受的吸入治疗类型的关系。LOS以均值和95%置信区间（95%CI）表示。
除血氧饱和度均值水平、呼吸评分和皮质类固醇使用存在差异外，各组相似。第4组儿童的平均呼吸评分最低，因为喘息和/或吸气凹陷的发生率低于其他组。第1组和第4组儿童的LOS（分别为43.2小时，95%CI 34.9 - 51.3，和44.1小时，95%CI 37.3 - 51.0）比第2组和第3组（分别为72小时，95%CI 62.1 - 81.6，和65.1小时，95%CI 54.7 - 75.6）短（p < 0.02）。调整协变量后，每组的平均LOS无显著变化。
2岁以下急性非重症细支气管炎患儿住院时间延长与雾化吸入3%盐水有关，与年龄、疾病临床表现或治疗中是否包含其他治疗无关。
