治疗时机问题：全身激素治疗儿童急性哮喘
2012/12/31
摘要
综述的目的：本文对目前全身激素治疗儿童急性哮喘的有效性进行综述，后者与治疗时机有关。
近期发现：阐述三个与哮喘儿童急性哮喘全身激素治疗时机有关的话题：早期全身激素治疗的证据；与全身激素治疗有关的因素；护士启动全身激素治疗的证据。
总结：全身激素治疗至起效之间的时间与入院风险成显著负相关。全身激素治疗时间的变化，可以解释临床上急性哮喘治疗效果存在差异。近期研究显示，早期全身激素治疗能显著降低住院率。针对成功改善住院率的急性哮喘治疗路径而言，这些路径的实施必须考虑使用全身皮质类固醇激素的障碍研究结果为急诊儿童哮喘全身激素治疗提供了指导。
（刘国梁 审校）
Curr Opin Pulm Med. 2013 Jan;19(1):73-8. doi: 10.1097/MCP.0b013e32835b590a.
A question of time: systemic corticosteroids in managing acute asthma in children.
Bhogal SK.
Source
Child Health Intervention & Longitudinal Development Program, University of New Brunswick, Fredericton, New Brunswick, Canada.
Abstract
PURPOSE OF REVIEW: The aim of this article is to examine the evidence for the effectiveness of systemic corticosteroids in managing acute asthma in children as it relates to the timing of its administration.
RECENT FINDINGS: Three themes relevant to the timing of systemic corticosteroid administration as it relates to managing acute asthma in children are addressed, namely the evidence for early administration of systemic corticosteroid; factors associated with the administration of systemic corticosteroids and evidence for nurse-initiated administration of systemic corticosteroid.
SUMMARY: There is a clear inverse relationship between time elapsed from the intake of systemic corticosteroids to disposition and the risk of admission. The variable timing of systemic corticosteroid may explain the variable success of clinical care pathways to manage acute asthma. Recent studies have documented a significant reduction hospital admission with early administration of systemic corticosteroid. For acute asthma pathways to succeed in improving hospital admission rates, implementation of such pathways must be linked to barriers to the administration of systemic corticosteroids. Findings from the studies cited provide guidance in the administration of systemic corticosteroids in children with asthma in the real life setting of an emergency department.
Curr Opin Pulm Med. 2013 Jan;19(1):73-8. doi: 10.1097/MCP.0b013e32835b590a.
综述的目的：本文对目前全身激素治疗儿童急性哮喘的有效性进行综述，后者与治疗时机有关。
近期发现：阐述三个与哮喘儿童急性哮喘全身激素治疗时机有关的话题：早期全身激素治疗的证据；与全身激素治疗有关的因素；护士启动全身激素治疗的证据。
总结：全身激素治疗至起效之间的时间与入院风险成显著负相关。全身激素治疗时间的变化，可以解释临床上急性哮喘治疗效果存在差异。近期研究显示，早期全身激素治疗能显著降低住院率。针对成功改善住院率的急性哮喘治疗路径而言，这些路径的实施必须考虑使用全身皮质类固醇激素的障碍研究结果为急诊儿童哮喘全身激素治疗提供了指导。
（刘国梁 审校）
Curr Opin Pulm Med. 2013 Jan;19(1):73-8. doi: 10.1097/MCP.0b013e32835b590a.
A question of time: systemic corticosteroids in managing acute asthma in children.
Bhogal SK.
Source
Child Health Intervention & Longitudinal Development Program, University of New Brunswick, Fredericton, New Brunswick, Canada.
Abstract
PURPOSE OF REVIEW: The aim of this article is to examine the evidence for the effectiveness of systemic corticosteroids in managing acute asthma in children as it relates to the timing of its administration.
RECENT FINDINGS: Three themes relevant to the timing of systemic corticosteroid administration as it relates to managing acute asthma in children are addressed, namely the evidence for early administration of systemic corticosteroid; factors associated with the administration of systemic corticosteroids and evidence for nurse-initiated administration of systemic corticosteroid.
SUMMARY: There is a clear inverse relationship between time elapsed from the intake of systemic corticosteroids to disposition and the risk of admission. The variable timing of systemic corticosteroid may explain the variable success of clinical care pathways to manage acute asthma. Recent studies have documented a significant reduction hospital admission with early administration of systemic corticosteroid. For acute asthma pathways to succeed in improving hospital admission rates, implementation of such pathways must be linked to barriers to the administration of systemic corticosteroids. Findings from the studies cited provide guidance in the administration of systemic corticosteroids in children with asthma in the real life setting of an emergency department.
Curr Opin Pulm Med. 2013 Jan;19(1):73-8. doi: 10.1097/MCP.0b013e32835b590a.
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