小儿支气管炎病程的临床特点及治疗策略的评价

O. Koloskova, T. Bilous, G. Bilyk, R. Tkachuk, M. Dikal
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引用次数: 0

摘要

呼吸系统疾病在儿科医生或家庭医生就诊中总是占很大比例,而支气管炎通常是急性呼吸系统疾病的常见临床表现。医生经常面临如何客观评估支气管炎临床表现的问题,现在对呼吸道症状的评估往往基于听诊时的咳嗽、呼吸短促或喘息等标准。然而,今天几乎没有根据上述标准的儿童支气管炎严重程度的数据。在切尔诺夫茨市医疗机构"地区儿童临床医院"的肺病学和过敏症科对158名患有支气管炎的儿童进行了队列研究。使用支气管炎严重程度评分(BSS)在住院开始和第3、7天评估支气管炎严重程度。根据该量表,30例患儿确诊为轻度支气管炎,构成临床I组,128例患儿确诊为中度支气管炎,构成临床II组。与轻度支气管炎患者相比,中度支气管树炎症的侵袭性支气管炎症伴复发的几率是轻度支气管炎患者的1.6倍,9.4%的患者有社区获得性肺炎发作史,长期住院治疗(优势比2.6),门诊治疗时间减半。通过对对照组儿童支气管炎临床严重程度的研究,可以确定中度支气管炎儿童在住院第7天出现更严重病程的机会增加(优势比为4.8),该组中68.7%的儿童持续咳嗽(优势比为3.8)。对住院治疗策略的评估表明,与轻病患儿相比,需要增加中度支气管炎患者的综合治疗量(优势比12.0,相对风险8.8),同时需要增加抗菌治疗的风险(优势比3.7,相对风险2.8)和静脉注射抗生素超过3天的风险(优势比5.0,相对风险1.1)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CLINICAL FEATURES OF THE COURSE AND ASSESSMENT OF TREATMENT STRATEGY IN CHILDREN WITH BRONCHITIS
Respiratory diseases always account for a significant proportion of visits to the pediatrician or family doctor, and bronchitis is usually a frequent clinical manifestation of acute respiratory diseases. The doctor often faces the question of how to objectively assess the clinical picture of bronchitis, and now the assessment of respiratory symptoms is often based on criteria such as cough, shortness of breath or wheezing on auscultation. However, today there are practically no data on the severity of bronchitis in children depending on the above criteria. A cohort of 158 children with bronchitis was created at the pulmonology and allergology Department of the Municipal Medical Institution "Regional Children's Clinical Hospital" in Chernivtsi. The severity of bronchitis was assessed at the beginning and on the 3rd and 7th day of inpatient using the Bronchitis Severity Score (BSS). According to this scale, mild bronchitis was verified in 30 patients which formed the I clinical group, and 128 children had moderate bronchitis (II clinical comparison group). Aggressive inflammation of the bronchi in children with moderate inflammation of the bronchial tree compared with patients with mild bronchitis was accompanied 1.6 times more often by recurrence, a history of episodes of community-acquired pneumonia in 9.4% of patients, long-term inpatient treatment (odds ratio 2.6) and halving the duration of the outpatient treatment period. The study of clinical severity of bronchitis in children of the comparison groups made it possible to establish an increase in the chances of a more severe course of the disease on the 7th day of hospitalization in children with moderate bronchitis (odds ratio 4.8) with persistence of cough in 68.7% of children in this group (odds ratio 3.8). Evaluation of inpatient treatment tactics indicated the need to increase the volume of complex therapy in patients with moderate bronchitis relative to children with mild disease (odds ratio 12.0, relative risk 8.8), as well as increasing the risk of the need for antibacterial therapy (odds ratio 3.7, relative risk 2.8) and the appointment of intravenous antibiotics for more than 3 days (odds ratio 5.0, relative risk 1.1).
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