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Chest:儿童慢性咳嗽和持续性细菌性支气管炎的管理:CHEST指南和专家组报告

2017-02-12 MedSci MedSci原创

湿性或伴有咳痰的咳嗽在儿童慢性咳嗽中十分常见的。Chest专家指南关于几个关键问题进行系统评价后提出建议:(KQ1)-抗生素在咳嗽的治疗效果方面有效吗?如果是,有什么效果,维持多长时间?(KQ2)-儿童何时应进行进一步评估?使用CHEST咳嗽专家组的方案以及美国胸科医师学院(CHEST)方法指南和GRADE框架进行系统评价。来自系统评价的数据结合患者的价值观和偏好以及临床背景最终形成推荐。最终,结

湿性或伴有咳痰的咳嗽在儿童慢性咳嗽中十分常见的。Chest专家指南关于几个关键问题进行系统评价后提出建议:(KQ1)-抗生素在咳嗽的治疗效果方面有效吗?如果是,有什么效果,维持多长时间?(KQ2)-儿童何时应进行进一步评估?


使用CHEST咳嗽专家组的方案以及美国胸科医师学院(CHEST)方法指南和GRADE框架进行系统评价。来自系统评价的数据结合患者的价值观和偏好以及临床背景最终形成推荐。

最终,结合来自系统评价的数据,发现在≤14岁的儿童中有高质量的证据,其中慢性(> 4周持续时间)湿性/伴有咳痰的咳嗽若使用适当的抗生素可以改善咳嗽;当存在咳嗽伴有其他体征(例如杵状指)时,应进行进一步的研究(例如纤维支气管镜检查,胸部CT和免疫测试)。

当使用4周抗生素后湿咳仍然不改善时,有中等质量的证据表明应进一步检查以寻找潜在的疾病。新的建议包括应该重视细菌性支气管炎的临床诊断分类。

与2006年的“咳嗽指南”相比,现在有高质量的证据表明在专业环境中有关于慢性湿咳的某些方面的管理。但是,仍然需要进一步的研究。

原始出处:
Chang AB, Oppenheimer JJ, Weinberger M, et al. Management of children with chronic wet cough and protracted bacterial bronchitis: CHEST Guideline and Expert Panel Report. Chest. 2017 Jan 28. pii: S0012-3692(17)30075-2.

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    2017-10-07 Smile2680
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1922550, encodeId=59f0192255000, content=<a href='/topic/show?id=3f3156324ff' target=_blank style='color:#2F92EE;'>#持续性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56324, encryptionId=3f3156324ff, topicName=持续性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Fri Sep 08 13:03:00 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050592, encodeId=293320505925a, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Feb 22 08:03:00 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929279, encodeId=6e3419292e971, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Sat Oct 07 10:03:00 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1892067, encodeId=11a3189206e8c, content=<a href='/topic/show?id=1b445e1232d' target=_blank style='color:#2F92EE;'>#支气管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57123, encryptionId=1b445e1232d, topicName=支气管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f503121, createdName=zjubiostat, createdTime=Thu Nov 02 00:03:00 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185078, encodeId=1d731850e8e4, content=最新进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=06e71731984, createdName=galeno, createdTime=Tue Apr 04 09:40:19 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029411, encodeId=c1b52029411c7, content=<a href='/topic/show?id=585a206e45e' target=_blank style='color:#2F92EE;'>#专家组#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20674, encryptionId=585a206e45e, topicName=专家组)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca6a2500099, createdName=more is better!, createdTime=Sun Nov 26 09:03:00 CST 2017, time=2017-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175771, encodeId=e6151e57711f, content=最新研究进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Feb 12 15:23:59 CST 2017, time=2017-02-12, status=1, ipAttribution=)]
    2017-04-04 galeno

    最新进展

    0

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  7. [GetPortalCommentsPageByObjectIdResponse(id=1922550, encodeId=59f0192255000, content=<a href='/topic/show?id=3f3156324ff' target=_blank style='color:#2F92EE;'>#持续性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56324, encryptionId=3f3156324ff, topicName=持续性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2c31495, createdName=liuyg0228, createdTime=Fri Sep 08 13:03:00 CST 2017, time=2017-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050592, encodeId=293320505925a, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Feb 22 08:03:00 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1929279, encodeId=6e3419292e971, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Sat Oct 07 10:03:00 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1892067, encodeId=11a3189206e8c, content=<a href='/topic/show?id=1b445e1232d' target=_blank style='color:#2F92EE;'>#支气管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57123, encryptionId=1b445e1232d, topicName=支气管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f503121, createdName=zjubiostat, createdTime=Thu Nov 02 00:03:00 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185078, encodeId=1d731850e8e4, content=最新进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=06e71731984, createdName=galeno, createdTime=Tue Apr 04 09:40:19 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029411, encodeId=c1b52029411c7, content=<a href='/topic/show?id=585a206e45e' target=_blank style='color:#2F92EE;'>#专家组#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20674, encryptionId=585a206e45e, topicName=专家组)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca6a2500099, createdName=more is better!, createdTime=Sun Nov 26 09:03:00 CST 2017, time=2017-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=175771, encodeId=e6151e57711f, content=最新研究进展, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sun Feb 12 15:23:59 CST 2017, time=2017-02-12, status=1, ipAttribution=)]
    2017-02-12 天涯183

    最新研究进展

    0

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