Hammer J
Intensivmedizin/Pneumologie, Universitäts-Kinderklinik Basel.
Schweiz Med Wochenschr. 1998 Sep 12;128(37):1366-74.
Respiratory syncytial virus is the most frequent cause of respiratory tract infections in infants and is responsible for annual winter epidemics of acute bronchiolitis. Over the last decades medical therapy has remained unchanged and controversial, despite intensive research. Inhaled bronchodilators are often not effective and should be discontinued if no beneficial response can be documented. Steroids and ribavirin are not indicated in previously healthy infants with acute RSV bronchiolitis. There is some evidence, however, that certain risk groups may benefit from their use. With good supportive care the mortality from RSV infection is now low. Postinfectious alterations in lung function are usually transient and reversible. High-risk infants can be protected from severe RSV infections by monthly infusions of RSV immune globulins. This treatment modality has, however, not gained wide acceptance because of the benign nature of the disease and the high costs and side effects of regular immune globulin infusions. An international consensus statement on the treatment of RSV bronchiolitis may help to reduce the wide differences in clinical practice.
呼吸道合胞病毒是婴儿呼吸道感染最常见的病因,也是每年冬季急性细支气管炎流行的罪魁祸首。在过去几十年里,尽管进行了深入研究,但药物治疗一直没有改变且存在争议。吸入性支气管扩张剂通常无效,如果没有可记录的有益反应,应停药。对于先前健康的急性呼吸道合胞病毒细支气管炎婴儿,不建议使用类固醇和利巴韦林。然而,有证据表明,某些高危人群可能会从使用这些药物中获益。通过良好的支持性护理,呼吸道合胞病毒感染的死亡率现在很低。感染后肺功能的改变通常是短暂且可逆的。高危婴儿可以通过每月输注呼吸道合胞病毒免疫球蛋白来预防严重的呼吸道合胞病毒感染。然而,由于该疾病的良性性质以及定期免疫球蛋白输注的高成本和副作用,这种治疗方式并未得到广泛认可。关于呼吸道合胞病毒细支气管炎治疗的国际共识声明可能有助于减少临床实践中的巨大差异。