Abstract:

Objective    To assess the effects of nebulised hypertonic （≥ 3%） saline solution （NHS） in infants with acute viral bronchiolitis. Methods    The PubMed，EMbase，Cochrane Library （Issue 5， 2015）， EMbase， CBM， CNKI， VIP and Wan Fang Data were searched up to January， 2015 to collect randomized controlled trials （RCTs） about the efficacy of NHS in treatment of acute bronchiolitis in infants. Two reviewers independently screened literature according to the inclusion and exclusion criteria， extracted data， and assessed methodological quality of included studies. Meta-analysis was then conducted using Metafor software. Results    A total of 17 RCTs， including 14 relatively high qualities RCT， were finally included. The results of Meta-analysis showed that： compared with control group， NHS group had better outcomes in duration （day） of hospitalization ［MD＝-0.58， 95%CI：-1.14 to -0.02， P＝0.0428］ and the clinical severity score （MD in day 1＝-0.66， 95%CI： -1 to -0.31，P＜0.0001）；  MD in day 2＝-0.8， 95%CI：-1.18 to -0.41， P＜0.0001； MD in day 3＝-0.93， 95%CI：-1.54 to -0.32， P＝0.0002）， all with significant differences. In comparison with control group in the department of emergent setting， NHS group showed the trend of reducing the admission of hospital （RR＝0.75）， but no statistical difference was observed. Conclusion    Nebulized HS treatment can significantly shorten the duration of hospitalization and improve the severity score. Due to the efficacy and cost-effectiveness， HS should be considered for the treatment of acute bronchiolitis in infants during hospitalization.

Key words: nebulized hypertonic saline, bronchiolitis in infants, systematic evaluation, Meta-analysis, randomized controlled trial

摘要：

目的    评价高渗盐水雾化吸入治疗婴幼儿毛细支气管炎的临床疗效。方法    计算机检索PubMed、EMbase、The Cochrane Library（2015年1期）、CBM、CNKI、VIP和WanFang Data数据库，纳入高渗盐水治疗毛细支气管炎的RCT，检索时限均为从建库至2015年1月。由2位研究者按纳入与排除标准筛选文献，在提取资料和评价纳入研究的方法学质量后获得高渗盐水治疗毛细支气管炎的RCT文献。依据随机方法、分配隐藏、盲法、结果数据的完整性、选择性报告研究结果和其他偏倚来源进行文献偏倚评价。应用Metafor软件进行Meta分析。结果    最终纳入17个RCT。文献偏倚评价结果显示，14个研究质量相对较高。Meta分析结果显示：（1）高渗盐水组较对照组可显著缩短住院患儿的住院时间 （住院天数的均数差异MD＝-0.58， 95%CI：-1.14～-0.02， P＝0.0428）。（2）高渗盐水组较对照组可有效改善患儿疾病的严重程度，临床病情严重度评分均数差异在第1天的MD＝-0.66（95%CI：-1～-0.31，P＜0.0001）；第2天的MD＝-0.8（95%CI：-1.18～-0.41，P＜0.0001）； 第3天的MD＝-0.93（95%CI：-1.54～-0.32， P＝0.0002）。（3）在门急诊患儿，高渗盐水组相对于对照组的入院风险RR＝0.75，但无统计学意义。结论    当前证据显示， 毛细支气管炎患儿在住院期间加用高渗盐水雾化吸入治疗可显著缩短住院时间并改善临床病情严重度评分。鉴于该治疗方法的有效性及廉价性，可以考虑将高渗盐水雾化吸入用于婴幼儿毛细支气管炎的治疗。

关键词: 高渗盐水雾化吸入, 婴幼儿毛细支气管炎, 系统评价, Meta分析, 随机对照试验