Elliott Anna Catherine, Williamson Graham R
Meneage Street Surgery, 100 Meneage Street, Helston, Cornwall TR17, 8RF, UK, 01326 555288.
Adult Nursing, School of Nursing and Midwifery, Plymouth University, Drake Circus, Plymouth, PL4 8AA. UK, 07976761858.
Open Nurs J. 2017 Nov 30;11:241-261. doi: 10.2174/1874434601711010241. eCollection 2017.
Many randomised control trials and systematic reviews have examined the benefits of glucocorticoids for the treatment of croup in children, but they have reported mainly on dexamethasone as an oral treatment for croup. No systematic reviews have examined prednisolone alone.
To determine in a systematic review of the literature whether a single dose of oral prednisolone is as effective as a single dose of dexamethasone for reducing croup symptoms in children.
A detailed search was conducted on the following databases: CINAHL, MEDLINE EBSCO, MEDLINE, OVID, PubMed, The Cochrane Library, ProQuest, EMBASE, JBI, Sum search, and OpenGrey. Study authors were contacted.
Randomised Controlled Trials, clinical trials or chart reviews which examined children with croup who were treated with prednisolone alone, or when prednisolone was compared to a dexamethasone treatment and the effectiveness of the intervention was objectively measured using croup scores and re-attendance as primary outcomes.
Following PRISMA guidelines for systematic reviews, relevant studies were identified. Scores were graded agreed by two independent reviewers using QualSyst.
Four studies met the inclusion criteria, but were too heterogeneous to combine in statistical meta-analysis. The result suggests that although prednisolone appears as effective as dexamethasone when first given, it is less so for preventing re-presentation. Trial sample sizes were small, making firm conclusions difficult, however, a second dose of prednisolone the following day may be useful. More research including cost-benefit analysis is needed to examine the efficacy of prednisolone compared to dexamethasone.
许多随机对照试验和系统评价研究了糖皮质激素治疗儿童哮吼的益处，但主要报道的是地塞米松作为哮吼的口服治疗药物。尚无系统评价单独研究泼尼松龙。
通过对文献的系统评价，确定单剂量口服泼尼松龙在减轻儿童哮吼症状方面是否与单剂量地塞米松同样有效。
对以下数据库进行了详细检索：护理学与健康领域数据库（CINAHL）、EBSCO平台的医学期刊数据库（MEDLINE EBSCO）、医学期刊数据库（MEDLINE）、OVID平台数据库、美国国立医学图书馆生物医学文献数据库（PubMed）、考克兰图书馆、ProQuest数据库、荷兰医学文摘数据库（EMBASE）、循证卫生保健中心循证卫生保健数据库（JBI）、综合检索平台（Sum search）和开放灰色文献数据库（OpenGrey）。并与研究作者进行了联系。
随机对照试验、临床试验或病历回顾，研究对象为仅接受泼尼松龙治疗的哮吼儿童，或泼尼松龙与地塞米松治疗进行比较，且使用哮吼评分和再次就诊情况作为主要结局指标客观衡量干预效果的研究。
按照系统评价的首选报告项目（PRISMA）指南，确定相关研究。由两名独立评审员使用质量评估系统（QualSyst）对评分进行分级。
四项研究符合纳入标准，但异质性过大，无法进行统计荟萃分析。结果表明，虽然首次给予时泼尼松龙似乎与地塞米松效果相同，但在预防再次就诊方面效果较差。试验样本量较小，难以得出确凿结论，不过，次日给予第二剂泼尼松龙可能会有帮助。需要更多研究（包括成本效益分析）来检验泼尼松龙与地塞米松相比的疗效。
