Smith Dustin K, Seales Sajeewane, Budzik Carol
Naval Hospital Jacksonville, Jacksonville, FL, USA.
Am Fam Physician. 2017 Jan 15;95(2):94-99.
Bronchiolitis is a common lower respiratory tract infection in infants and young children, and respiratory syncytial virus (RSV) is the most common cause of this infection. RSV is transmitted through contact with respiratory droplets either directly from an infected person or self-inoculation by contaminated secretions on surfaces. Patients with RSV bronchiolitis usually present with two to four days of upper respiratory tract symptoms such as fever, rhinorrhea, and congestion, followed by lower respiratory tract symptoms such as increasing cough, wheezing, and increased respiratory effort. In 2014, the American Academy of Pediatrics updated its clinical practice guideline for diagnosis and management of RSV bronchiolitis to minimize unnecessary diagnostic testing and interventions. Bronchiolitis remains a clinical diagnosis, and diagnostic testing is not routinely recommended. Treatment of RSV infection is mainly supportive, and modalities such as bronchodilators, epinephrine, corticosteroids, hypertonic saline, and antibiotics are generally not useful. Evidence supports using supplemental oxygen to maintain adequate oxygen saturation; however, continuous pulse oximetry is no longer required. The other mainstay of therapy is intravenous or nasogastric administration of fluids for infants who cannot maintain their hydration status with oral fluid intake. Educating parents on reducing the risk of infection is one of the most important things a physician can do to help prevent RSV infection, especially early in life. Children at risk of severe lower respiratory tract infection should receive immunoprophylaxis with palivizumab, a humanized monoclonal antibody, in up to five monthly doses. Prophylaxis guidelines are restricted to infants born before 29 weeks' gestation, infants with chronic lung disease of prematurity, and infants and children with hemodynamically significant heart disease.
细支气管炎是婴幼儿常见的下呼吸道感染，呼吸道合胞病毒（RSV）是这种感染最常见的病因。RSV通过与受感染人员直接产生的呼吸道飞沫接触或通过接触被污染表面的分泌物进行自我接种传播。RSV细支气管炎患者通常先出现两到四天的上呼吸道症状，如发热、流涕和鼻塞，随后出现下呼吸道症状，如咳嗽加重、喘息和呼吸费力增加。2014年，美国儿科学会更新了其关于RSV细支气管炎诊断和管理的临床实践指南，以尽量减少不必要的诊断测试和干预措施。细支气管炎仍然是一种临床诊断，通常不建议进行诊断测试。RSV感染的治疗主要是支持性的，支气管扩张剂、肾上腺素、皮质类固醇、高渗盐水和抗生素等治疗方式一般无效。有证据支持使用补充氧气来维持足够的氧饱和度；然而，不再需要持续脉搏血氧饱和度监测。治疗的另一个主要方法是，对于无法通过口服液体摄入维持水合状态的婴儿，通过静脉或鼻胃管给予液体。教育家长降低感染风险是医生帮助预防RSV感染（尤其是在生命早期）最重要的事情之一。有严重下呼吸道感染风险的儿童应接受帕利珠单抗免疫预防，这是一种人源化单克隆抗体，每月最多注射五剂。预防指南仅限于妊娠29周前出生的婴儿、早产慢性肺病婴儿以及有血流动力学显著意义心脏病的婴儿和儿童。
