为儿童臀部喷雾肾上腺素。

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Bjornson C,罗素K,范德米尔B,克拉森TP,约翰逊DW

为儿童臀部喷雾肾上腺素。

科克伦数据库系统启2013 10月10;(10):CD006619。cd006619.pub3 doi: 10.1002/14651858.。

PubMed ID

24114291 (在PubMed

]

文摘

背景:臀部是一种常见的儿童疾病,其特征是含有树皮的咳嗽、喘鸣,声音沙哑,呼吸窘迫。孩子有严重的臀部是插管的风险。喷雾肾上腺素可以预防插管。目的:评估疗效(衡量臀部分数,插管率和医疗利用率住院率等)和安全(频率和严重程度的副作用)的喷雾肾上腺素和安慰剂在臀部的孩子,在紧急情况下评估部门(ED)或医院设置。必威国际app搜索方法:我们在2013年中央,问题6,MEDLINE(1966年至2013年6月星期3)、EMBASE(1980年至2013年7月),科学(1974年至2013年7月),Web CINAHL(1982年至2013年7月)和斯高帕斯(1996年至2013年7月)。选择标准:随机对照试验(相关的)或quasi-RCTs臀部评估患儿的ED或住院。比较:喷雾肾上腺素和安慰剂,外消旋喷雾肾上腺素和L-epinephrine(同分异构体)和喷雾肾上腺素由间歇正压呼吸(IPPB)与喷雾没有IPPB肾上腺素。主要结果是臀部评分治疗后的变化。二次结果率和插管时间和住院,臀部回访,家长的焦虑和副作用。数据收集和分析:两位作者独立识别潜在相关的研究题目和摘要(如果可用)和检查相关研究使用先验入选标准,其次是方法论的质量评估。 One author extracted data while the second checked accuracy. We use the standard methodological procedures expected by the Cochrane Collaboration. MAIN RESULTS: Eight studies (225 participants) were included. In general, children included in the studies were young (average age less than two years in the majority of included studies). Severity of croup was described as moderate to severe in all included studies. Six studies took place in the inpatient setting, one in the ED and one setting was not specified. Six of the eight studies were deemed to have a low risk of bias and the risk of bias was unclear in the remaining two studies.Nebulized epinephrine was associated with croup score improvement 30 minutes post-treatment (three RCTs, standardized mean difference (SMD) -0.94; 95% confidence interval (CI) -1.37 to -0.51; I(2) statistic = 0%). This effect was not significant two and six hours post-treatment. Nebulized epinephrine was associated with significantly shorter hospital stay than placebo (one RCT, MD -32.0 hours; 95% CI -59.1 to -4.9). Comparing racemic and L-epinephrine, no difference in croup score was found after 30 minutes (SMD 0.33; 95% CI -0.42 to 1.08). After two hours, L-epinephrine showed significant reduction compared with racemic epinephrine (one RCT, SMD 0.87; 95% CI 0.09 to 1.65). There was no significant difference in croup score between administration of nebulized epinephrine via IPPB versus nebulization alone at 30 minutes (one RCT, SMD -0.14; 95% CI -1.24 to 0.95) or two hours (SMD -0.72; 95% CI -1.86 to 0.42). None of the studies sought or reported data on adverse effects. AUTHORS' CONCLUSIONS: Nebulized epinephrine is associated with clinically and statistically significant transient reduction of symptoms of croup 30 minutes post-treatment. Evidence does not favor racemic epinephrine or L-epinephrine, or IPPB over simple nebulization.The authors note that data and analyses were limited by the small number of relevant studies and total number of participants and thus most outcomes contained data from very few or even single studies.

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药物

肾上腺素