雾化吸入高渗盐水治疗婴幼儿毛细支气管炎疗效和安全性的Meta分析

目的评价高渗盐水治疗婴幼儿毛细支气管炎的疗效和安全性,为临床治疗提供依据。方法检索PubMed、EMBASE、Cochrane图书馆、Cochrane临床对照试验库、维普中文科技期刊数据库、中国知网和万方数据库,检索时间均从建库至2011年4月。获得高渗盐水治疗毛细支气管炎的RCT文献。依据随机方法、分配隐藏、盲法、结果数据的完整性、选择性报告研究结果和其他偏倚来源进行文献偏倚评价。应用RevMan 5.1.1软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果10篇RCT文献进入Meta分析。文献偏倚评价结果显示,8篇文献存在低度偏倚风险,2篇文献存在中度偏倚风险。①高渗盐水组较对照组可显著缩短住院时间（MD=-1.33 d,95%CI:-1.63~-1.03 d, P< 0.000 01）。②高渗盐水组较对照组可显著降低治疗后临床病情严重度评分 (第1天：MD=-0.77,95%CI:-1.30 ~-0.24,P=0.004;第2天：MD=-1.15,95%CI:-1.86~-0.44,P=0.001;第3天:MD=-1.43,95%CI:-1.87 ~-0.99,P<0.000 01)。③高渗盐水组较对照组可显著缩短喘息缓解时间、咳嗽缓解时间和肺部湿啰音消失时间,MD分别为-1.16 d（95%CI:-1.43~-0.89 d,P<0.000 01）、-1.12 d（95%CI:-1.34~-0.89 d,P<0.000 01）和-1.30 d（95%CI:-2.29~-0.32 d,P=0.009）。④高渗盐水组住院率、再住院率、呼吸窘迫评分和治疗后3 d胸部X线片评分与对照组差异均无统计学意义。⑤高渗盐水组未观察到急性支气管痉挛等严重不良反应。结论现有证据显示,高渗盐水治疗毛细支气管炎可显著缩短住院时间,并能降低患儿临床病情严重度评分,可显著缩短喘息缓解时间、咳嗽缓解时间和肺部湿啰音消失时间,未见严重不良反应。     

Effectiveness of oral or nebulized dexamethasone for children with mild croup.

OBJECTIVE: To assess the efficacy of oral dexamethasone or nebulized dexamethasone sodium phosphate in children with mild croup. METHODS: Double-blind, placebo-controlled study of 264 children between 6 months and 6 years of age with symptoms of croup for fewer than 48 hours. Patients were excluded if they received racemic epinephrine or corticosteroid treatment. Other exclusion criteria included corticosteroid treatment during the 14 days prior to enrollment or complicating medical condition. Subjects randomly received oral dexamethasone (0.6 mg/kg), nebulized dexamethasone sodium phosphate (160 microg), or placebo. Telephone follow-up was obtained on days 1, 2, 3, 4, and 7. MAIN OUTCOME MEASURES: The primary outcome measure was treatment failure, defined as receiving corticosteroid or racemic epinephrine treatment during the 7 days after enrollment in the study. Secondary outcome measures included seeking additional care and the parental assessments of the patients' condition obtained during follow-up (worse, same, better, or gone). RESULTS: Eighty-five patients received oral dexamethasone, 91 received nebulized dexamethasone, and 88 received placebo. There were 3 treatment failures in the oral dexamethasone-treated group, 12 in the nebulized dexamethasone-treated group, and 10 in the placebo-treated group (P =.05). Ten children in the oral dexamethasone-treated group sought additional care compared with 27 and 29 in the nebulized dexamethasone-treated and placebo-treated groups, respectively (P =.002). Parents of children in the oral dexamethasone-treated group reported greater improvement on day 1 (P<.001) compared with the nebulized dexamethasone-treated and placebo-treated groups. CONCLUSIONS: Children with mild croup who receive oral dexamethasone treatment are less likely to seek subsequent medical care and demonstrate more rapid symptom resolution compared with children who receive nebulized dexamethasone or placebo treatment.     

Additive effects of dexamethasone in nebulized salbutamol or l-epinephrine treated infants with acute bronchiolitis

BACKGROUND: Although it is the most common lower respiratory infection of infancy, the optimal treatment for acute bronchiolitis is still controversial. The aim of this study was to compare the early and late effects of nebulized L-epinephrine (EPI) and intramuscular dexamethasone (DEX) combination therapy with nebulized salbutamol (SAL) and dexamethasone combination and bronchodilators alone in outpatients with acute bronchiolitis. METHODS: A total of 69 infants aged 2-21 months who were admitted to the Pediatrics Department of the Faculty of Medicine, Mersin University, with acute bronchiolitis were included in a randomized, placebo-controlled, prospective trial study. Patients were assigned to receive either nebulized L-epinephrine (3 mg) or salbutamol (0.15 mg/kg) and 15 min later, either dexamethasone 0.6 mg/kg or placebo (PLA), intramuscularly, in a double-blind randomized fashion. The study groups were: epinephrine + dexamethasone group (group 1, n=23), salbutamol + dexamethasone group (group 2, n=23), epinephrine + placebo group (group 3, n=11), and salbutamol + placebo group (group 4, n=12). The outcome measures were heart rate, respiratory rate and Respiratory Distress Assessment Instrument (RDAI) score determined at 30, 60, 90 and 120 min, 24 h, and 5 days after the first therapy. Patients were then followed-up during the subsequent 2 months for the prevalance of respiratory complaints regarding bronchial hyperreactivity. RESULTS: There were no significant differences between the outcome variables of the four groups within the first 120 min and at 24 hours, or between the rates of requirement of a second dose of the same bronchodilator. However, fifth day RDAI score values of both DEX groups were significantly lower than that of SAL + PLA group (P=0.000 and P=0.01, respectively). The fifth day score value of group 1 was also significantly better than that value of EPI + PLA group but not different from group 2. CONCLUSIONS: A single dose of intramuscular dexamethasone added to nebulized L-epinephrine, or salbutamol therapies resulted in better outcome measures than bronchodilators alone in the late phase (fifth day) of mild to moderate degree bronchiolitis attack. However, effects of EPI + DEX combination was not different from SAL + DEX combination.     

Efficacy of adding nebulized ipratropium bromide to nebulized albuterol therapy in acute bronchiolitis.

Nebulized ipratropium bromide is though to be synergistic with albuterol in therapy for acute childhood asthma. Because the efficacy of ipratropium in bronchiolitis is uncertain and some infants with bronchiolitis do not respond to nebulized albuterol alone, the following study was undertaken. In this double-blind, placebo-controlled trial, 69 infants between 6 weeks and 24 months of age who exhibited the first episode of acute bronchiolitis were randomly assigned to receive either nebulized albuterol (0.15 mg/kg per dose) and ipratropium bromide (250 micrograms per dose) (group A, n = 36) or nebulized albuterol and normal saline (placebo) (group B, n = 33) for two doses, 1 hour apart. The two groups were comparable at baseline. Both therapies resulted in clinically significant improvement. However, the addition of ipratropium resulted in no additional benefit with respect to decrease in the respiratory rate (mean decreases 10.6/min vs decreases 8.6/min, P = .86), accessory muscle score (range 0 through 3) (decreases 0.92 vs decreases 0.82, z = -0.44), wheeze score (range 0 through 3) (decreases 0.94 vs 0.85, z = -0.20), oxygen saturation (increases 0.25% vs increases -0.33%, P = .86), or hospitalization rate (17 vs 10). The number of "nonresponders" and "clear responders" was also very similar in both groups. No toxicity was noted. The increase in heart rate was mild and similar in both groups (increases 6.7 vs increases 11.1). The power of the study to detect a difference between the two treatment groups in the respiratory rate change > or = 8/min is greater than 90%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Efficacy of oral dexamethasone in outpatients with acute bronchiolitis

OBJECTIVE: To examine the efficacy of oral dexamethasone in acute bronchiolitis. STUDY DESIGN: A double-blind randomized, placebo-controlled trial involving 70 children < 24 months old in the emergency department with Respiratory Disease Assessment Instrument > or = 6. Each patient received either 1 dose of 1 mg/kg of oral dexamethasone or placebo and was assessed hourly for a 4-hour period. Repeated measures regression analysis evaluated a change in the Respiratory Assessment Change Score (RACS). RESULTS: The 2 groups had similar baseline characteristics with Respiratory Disease Assessment Inventory of 9.4 +/- 2.3 in the dexamethasone group (n = 36) and 10.0 +/- 2.7 in the placebo group (n = 34). The RACS was -5.0 +/- 3.1 in the dexamethasone group and -3.2 +/- 3.7 in the placebo group (P =.029). Poor RACS occurred in 41% and 17% of the placebo and dexamethasone groups, respectively (P =.034). Of the children treated with dexamethasone, 19% were hospitalized compared with 44% in the placebo group (P =.039). There was no difference in RACS between the groups on day 7 (P =.75). CONCLUSION: Outpatients with moderate-to-severe acute bronchiolitis derive significant clinical and hospitalization benefit from oral dexamethasone treatment in the initial 4 hours of therapy.     

Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma

To evaluate the efficacy of nebulized budesonide compared to oral prednisolone early in the emergency room management of acute asthma, we conducted a double-blind, placebo-controlled trial. Eighty children, 2 years to 12 years of age, with acute moderate attacks of asthma, were randomized into two groups. One group received nebulized salbutamol (0.15 mg/kg) and placebo at half-hourly intervals for three doses, and a single dose of oral prednisolone (2 mg/kg) (prednisolone group) and other group received three doses of nebulized salbutamol and budesonide (800 microg) at half-hourly intervals and a single dose of placebo tablets (budesonide group). The baseline characteristics of the two groups were similar, but after three doses of nebulization oxygen saturation, respiratory rate, pulmonary index and respiratory distress score were significantly improved in the budesonide group compared to prednisolone group (p < 0.01). The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was significantly higher in the budesonide group than in the prednisolone group (22/ 41, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of nebulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy.     

Efficacy and safety of felbamate in children with refractory epilepsy

BackgroundDespite the introduction of multiple new antiepileptic drugs in the past two decades, many patients with epilepsy continue to experience uncontrolled seizures or significant side effects.AimTo present our experience with felbamate therapy in children with drug-resistant epilepsy.MethodsWe retrospectively reviewed the medical charts and video-EEG recordings of all patients receiving felbamate until May 2012. Efficacy was determined according to seizure frequency during the week prior to treatment initiation and the week after the maximal dosage of felbamate was reached.ResultsFifty patients (34 boys) aged 4 months to 17 years (mean – 5.5 years) were identified. Nearly third of the patients had Lennox–Gastaut syndrome. Mean epilepsy duration was 3.4 years (range – 1 month to 13 years). The mean number of previous antiepileptic drugs was 7.5. The mean duration of follow-up was 1.1 years. Seizure frequency decreased by at least 50% in 29 (58%) patients. Side effects were reported in 22 (44%) patients, none of them included aplastic anemia or liver failure. In the responder group, the maximal dose of felbamate was lower and the patients were older compared to non-responders.ConclusionsDespite current recommendations, felbamate is initiated following multiple AEDs. Based on its efficacy and safety data, earlier initiation of felbamate is recommended in children with refractory epilepsy.     

Efficacy and safety of linezolid in immunocompromised children with cancer

Background: The aim of this study was to determine the safety, tolerance and efficacy of linezolid for the treatment of infections from Gram‐positive bacteria in immunocompromised children with cancer. Methods: This was a prospective non‐comparative unblinded study in the Hematology/Oncology Unit over a two‐year period, administering linezolid as monotherapy in children with cancer. Results: Seventeen children received linezolid (30 mg/kgr: 3 i.v. per day). Mean duration of linezolid administration was 12.2 days (range, 6–38 days), while the median age of the evaluable patients was 2.2 years (range, 6 months–11.2 years). Primary diagnosis was acute lymphoblastic leukemia (nine patients), brain tumor (three patients), multi‐organ Langerhans cell histiocytosis (two patients), rhabdomyosarcoma, Burkitt's lymphoma and ovarian tumor (one patient each). All patients were in the midst of chemotherapy cycles. Ten out of 17 children had positive blood cultures (methicillin‐resistant Staphylococcus aureus, four patients; vancomycin‐resistant Enterococcus, three patients; penicillin‐resistant Streptococcus pneumoniae, three patients), while seven of the 17 had fever and vancomycin‐resistant Enterococcus in stool cultures. All patients were considered clinically cured after the end of the linezolid regimen (100% efficacy). The main adverse events were thrombocytopenia grade 1–3 and anemia grade 2–3 (four and two patients, respectively). Chemotherapy‐induced myelotoxicity (six patients) was not worsened during linezolid therapy. No bleeding episodes were presented. Self‐limited diarrhea grade 1–2 was presented in four patients (mean duration 2 days). The total adverse event rate was 23.5%; however, there was no premature cessation of linezolid in any patient. Conclusions: Linezolid may be another effective and safe therapy to treat infections from resistant Gram‐positive bacteria in immunocompromised children, even in young ages.     

不同药物雾化吸入治疗毛细支气管炎的疗效观察

目的　观察甲组 (喘乐宁组 )、乙组 (病毒唑组 )、丙组 (喘乐宁 +普米克令舒组 )治疗毛细支气管炎(毛支 )的疗效。方法　将 53例毛支患儿随机分为甲、乙、丙三组 ,三组均在综合治疗基础上 ,甲组加用喘乐宁雾化吸入 ,乙组加用大剂量病毒唑雾化吸入 ,丙组用喘乐宁与普米克令舒雾化吸入 ,对治疗前、后临床表现消失时间、治愈率进行疗效比较。结果　丙组疗效明显优于其他两组 ,乙组又优于甲组 (P <0 .0 5)。结论　喘乐宁与普米克令舒联合雾化吸入治疗毛支有协同作用 ,可缩短病程 ,提高治愈率 ,可作为佐治毛支的主要药物     

Localised ileal perforation associated with antenatal sulindac and dexamethasone treatment

A preterm neonate exposed antenatally to sulindac and dexamethasone was found to have a localised ileal perforation soon after birth. Unlike necrotising enterocolitis, drug-mediated ischaemic focal small-bowel perforation is associated with a benign clinical course and good prognosis when promptly treated. As antenatal sulindac and dexamethasone are being used with increasing frequency in obstetrics, all rare and life-threatening complications should be reported so that the benefits and risks can be critically assessed.     

利巴韦林气雾剂治疗小儿手足口病的有效性和安全性研究

目的 评价利巴韦林气雾剂治疗手足口病（HFMD）患儿的有效性和安全性。方法 采用随机、双盲、对照研究方法。119 例轻症HFMD 患儿随机分为试验组（59 例）和对照组（60 例）。试验组应用利巴韦林气雾剂治疗,首次使用1 h 内喷4 次,以后每隔1 h 喷1 次;2 日以后,一日4 次,每次2~3 揿,连续用药7 d。对照组采用安慰剂,用法同试验组。两组均加用“抗病毒口服液”口服。记录治疗前和治疗后口腔溃疡、皮疹、鼻塞、流涕、喷嚏、咳嗽、发热等临床症状评分,评价治疗效果;分别于治疗前、治疗后5~7 d 取咽拭子,用RT-PCR 法检测病毒载量以评价两组阴转率。结果 完成研究报告表规定内容的受试者试验组有57 例,对照组56 例。用药5~7 d 后,试验组肠道病毒总阴转率高于对照组（P<0.01）;试验组和对照组的综合疗效评价总显效率分别为89%、29%,总有效率分别为89%、43%,试验组的总显效率和总有效率均高于对照组。用药后两组均无头晕、呕吐等不良反应发生,外周血三系指标均无明显下降。结论 利巴韦林气雾剂治疗轻症HFMD 疗效确切,用药剂量小、不良反应轻,值得临床推广应用。     

Efficacy and safety of lamotrigine monotherapy in children and adolescents with epilepsy

Lamotrigine (LTG) has shown to confer broad-spectrum, well-tolerated control of epilepsy. Monotherapy is preferable over polytherapy because of better compliance, fewer adverse events, less interactions, lower teratogenicity and lower cost. The aim of this study is to evaluate the efficacy and safety of LTG monotherapy on seizure control in a cohort of children and adolescents with epilepsy.We retrospectively reviewed the records of children and adolescents treated with LTG monotherapy at our institution between 2001 and 2006. Data collected included demographics, seizure type, etiology of seizures, age at onset of seizures and at initiation of LTG treatment, number of antiepileptic drugs (AEDs) prior to LTG, dose of LTG, length of follow-up, treatment response, and adverse events.Seventy-two children and adolescents were identified (mean age 12.1 years); 37.5% had mental retardation. Age at onset of epilepsy was 5.7 years (0–16). Twenty three percent had symptomatic focal epilepsy, 15.5% idiopathic focal epilepsy, 19.4% symptomatic generalized epilepsy and 41.6% idiopathic generalized epilepsy. LTG was used as first-line monotherapy in 26.4% of patients and as a second-line monotherapy in 73.6%. Age at initiation of LTG therapy was 10 years (2.8–19). Mean number of AEDs tried prior to LTG was 1.3 (0–6). Mean dose of LTG was 5.5 mg/kg/day (1.1–13.7). Mean follow-up period was 33 months (3 weeks to 11.5 years).The degree of seizure reduction was as follows: seizure free in 42%, 75–90% reduction in 17.4%, 50–74% in 11.6%, 25–49% in 10%. Sixteen percent had no change in seizure control and 3% became worse. The most common adverse event was rash (6.9%). Six (8.3%) patients discontinued LTG because of the adverse events. No patient had Stevens–Johnson syndrome.In conclusion, LTG was effective and well-tolerated as monotherapy in children and adolescents for both focal and generalized epilepsies.     

Efficacy and safety of caspofungin therapy in children with invasive fungal infections

Twenty children with proven (n = 12) or probable (n = 8) invasive fungal infections received caspofungin treatment either as first-line (n = 7) or as salvage (n = 13) therapy and as monotherapy (n = 5) or in combination (n = 15). Eleven had aspergillosis, 7 had candidiasis, and 2 had Rhodotorula infections. Caspofungin was well tolerated. Nine patients experienced 11 drug-related adverse events, none were severe, and none led to drug discontinuation. Caspofungin as a first-line treatment was successful in 5 of the 7 children (these 5 patients survived the infectious episode, with a follow-up of 147 days), and salvage therapy rescued 8 of 13 children, but only 5 of them survived.