慢性湿性或排痰性咳嗽患儿的治疗和检查：一项系统性回顾
2016/01/14
摘要
背景：我们采用了系统性回顾以调查小儿慢性湿性咳嗽相关的关键问题(KQs)。对于与支气管扩张无关的慢性（>4周）湿性/排痰性咳嗽患儿，(KQ1)-抗生素在改善咳嗽方面是否有效？如果有效，效果是什么？有效期是多久？(KQ2)-什么时候应对患儿进行进一步的检查？
方法：我们使用了CHEST咳嗽专家委员会的协议。两位作者筛选搜索、选择和提取了数据。数据涵盖了英文的系统性回顾、随机对照试验(RCTs)、队列（前瞻性和回顾性）和横断面研究。
结果：数据以PRISMA流程图和表格总结的形式呈现。就KQ1，共纳入15项研究（3项系统性回顾、3项RCTs、5项前瞻性研究和4项回顾性研究）；就KQ2，共纳入17项研究（1项RCT、11项前瞻性研究和5项回顾性研究）。就RCTs(KQ1)的数据结合来看，为解决咳嗽而需要治疗的数量为3(95%CI 2.0-4.3)。总之，来源于前瞻性和回顾性研究的结果是一致的，但是存在较小的变动。
结论：有高质量的证据表明：对于≤14岁的慢性（>4周）湿性或排痰性咳嗽患儿，恰当地使用抗生素能够改善咳嗽。也有高质量的证据表明：当湿性咳嗽患儿存在特殊的咳嗽指征（如杵状指）时，需要进一步的检查（如可曲性支气管镜、胸部CTs和免疫试验）。当使用4周抗生素而湿性咳嗽仍不改善时，有中等质量的证据表明患儿应该被送至主要的医疗中心并考虑做进一步的检查以确定是否存在潜在的肺部疾病或其它疾病。
（苏欣 审校）
Chest. 2015 Nov 5. doi: 10.1378/15-2065. [Epub ahead of print]
Children with chronic wet or productive cough - treatment and investigations: a systematic review.
Chang AB, Oppenheimer JJ, Weinberger M, Rubin BK, Irwin RS.
Abstract
BACKGROUND:We undertook systematic reviews to examine key questions (KQs) related to pediatric chronic wet cough. In children with chronic (>4-weeks) wet/productive cough not related to bronchiectasis; (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2)-when should they be referred for further investigations?
METHODS:We used the CHEST expert cough panel's protocol. Two authors screened searches, selected and extracted data. Systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) and cross-sectional studies published in English were included.
RESULTS:Data were presented in PRISMA flowcharts and summaries tabulated. Fifteen studies were included in KQ1 (systematic reviews=3, RCTs=3, prospective studies=5, retrospective studies=4) and 17 in KQ2 (RCT=1, prospective=11, retrospective=5). Combining data from RCTs (KQ1), the number needed to treat for benefit was 3 (95%CI 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent but there were minor variations.
CONCLUSION:There is high quality evidence that in children aged ≤14-years with chronic (>4-weeks duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high quality evidence that when specific cough pointers (e.g. digital clubbing) are present in children with wetcough, further investigations (e.g. flexible bronchoscopy, chest CTs and immunity tests) should be undertaken. When the wet cough does not improve by 4-weeks of antibiotics, there is moderate quality evidence that children should be referred to a major center for consideration of further investigations to determine whether an underlying lung or other disease are present.
Chest. 2015 Nov 5. doi: 10.1378/15-2065. [Epub ahead of print]
