Postma D S, Jones R O, Pillsbury H C
Laryngoscope. 1984 Sep;94(9):1170-5. doi: 10.1288/00005537-198409000-00008.
We have reviewed 43 cases of severe croup admitted from 1977 to 1981 at North Carolina Memorial Hospital. All patients were treated with mist, 23 (54%) of 43 were treated with racemic epinephrine, but only 7 (16%) of 43 were treated with steroids. None of the 5 patients who required intubation received steroids. Nine (36%) of 25 patients available for at least 6 months of follow-up had subsequent clinical diagnoses of asthma. We have concluded that: 1. males with subglottic narrowing on x-ray, high leukocyte counts, and no steroid treatment appear to have increased need for airway support; 2. while humidification and racemic epinephrine are accepted forms of treatment, steroids are still rarely used even in severe croup; 3. severe croup may be a signal for the later development of asthma. Because it is difficult to predict which patients with severe croup will need later airway management, we strongly recommend that all patients with croup requiring racemic epinephrine be treated with at least a single dose of 1.0 to 1.5 mg/kg of dexamethasone.
我们回顾了1977年至1981年期间收治于北卡罗来纳州纪念医院的43例重症喉炎病例。所有患者均接受了雾化治疗，43例中有23例（54%）接受了消旋肾上腺素治疗，但43例中只有7例（16%）接受了类固醇治疗。5例需要插管的患者均未接受类固醇治疗。在25例可进行至少6个月随访的患者中，有9例（36%）随后被临床诊断为哮喘。我们得出以下结论：1. 男性患者若X线显示声门下狭窄、白细胞计数高且未接受类固醇治疗，似乎对气道支持的需求增加；2. 虽然湿化和消旋肾上腺素是公认的治疗方式，但即使在重症喉炎中类固醇仍很少使用；3. 重症喉炎可能是哮喘后期发展的一个信号。由于难以预测哪些重症喉炎患者后期需要气道管理，我们强烈建议所有需要消旋肾上腺素治疗的喉炎患者至少接受一剂1.0至1.5毫克/千克的地塞米松治疗。
