最新Bronchiolitis Guidelines and Evidence-Based Medicine …：毛细支气管炎指南和循证医学…-药学医学精品资料.ppt

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1、最新BronchiolitisGuidelinesandEvidence-BasedMedicine…：毛细支气管炎指南和循证医学…-药学医学精品资料Bronchiolitis:DefinitionViralinfectionofthelowerrespiratorytractcharacterizedbyacuteinflammation,edema,andnecrosisofepithelialcellsliningsmallairways,increasedmucusproduction,andbronchosp

2、asmAHRQEvidenceReportSeasonalityBronchiolitisRSVIsolatesYearHall,NEJM2001RSVPrimeCauseofLRTIinYoungChildHospitalizationforRSVBronchiolitis:38%ofallLRTIinfirstyearoflife22%ofallLRTIin5yearsofage31/1,000children<12moseachyearEconomicBurdenCostsforLRTIhospitaliza

3、tions:$2.25billionforinfants,14to26%fromRSV$3.73billionforfirst5yearsoflife,1016%fromRSVShay’99Stang’01ClinicalcourseofbronchiolitisIncubationperiod:2-8daysUpperrespiratoryinfection:1-3daysWorseninglowerairwaydisease:3-5daysFullrecovery:2-8weeksPercentDaysofsym

4、ptomsSwingleretal.2000ClinicalcourseSeverityDaysRiskFactorsforHospitalizationwithRSV1708HospitalizedInfantsinRochester,NYPrematurityChronicDiseaseAge<6wks1ormoreRiskFactorsPercentwith:RSVRoentgenographicFindingsDiffuseinterstitialpneumonitismostcommoninalllobesH

5、yperaeration>50%Lobarorsegmentalconsolidation2050%;RUL,RMLmostcommonPeribronchialthickeningTherapyforRSVOxygen,administeredbymeansofasmalltent,givesthesepatientswithcyanosisdefiniterelief,andisthetreatmentuponwhichwehavetorelyforthemostseverelyillinfants.J.Ada

6、ms,Lancet1945TherapiesSupportivecareAirwayclearanceHydrationOxygenBronchodilatorsSupportiveCareAdministerhumidifiedoxygenNasalsuctioningtoclearupperairwayMonitorforapnea,hypoxemia,andimpendingrespiratoryfailureNormalizebodytemperatureRehydratewithoralorintraveno

7、usfluidsMonitorhydrationstatusSupportiveCareQuittellLM,etal.AmRevRespirDis.1988;137:406A;ChestPhysiotherapy(CPT)LittleevidencetoconfirmenhancementofmucociliaryclearanceBronchodilatorsMultiplestudiesofbronchodilatorsAlbuterolBeta2adrenergiceffectsRacemicepinephri

8、neBeta2adrenergiceffectsAlphaadrenergiceffects-?vasoconstrictionAnticholinergicsNoevidenceforbenefitinbronchiolitisEffectonclinicalscore:Cochranemeta-analysisHartling