霧化吸入高滲鹽水對急診急性細支氣管炎嬰幼兒住院率之影響

The Effect of Nebulized Hypertonic Saline on Admission Rate in Infants with Acute Bronchiolitis in the Emergency Department

急性細支氣管炎是造成幼兒住院之主要原因，霧化吸入高滲鹽水是目前較一致認可的治療選項，因此，陸續有研究探討高滲鹽水對急性細支氣管炎之成效，且除了常見的3%，亦有5%及7%濃度的高滲鹽水，本研究目的即針對急診場域，統整霧化吸入高滲鹽水對降低急性細支氣管炎嬰幼兒住院率之實證，搜尋1997年1月至2017年7月前發表的中、英文文獻，於The Cochrane Library、PubMed、Medline、ProQuest等五個資料庫中搜尋，最後共得9篇高品質之隨機控制試驗，研究結果發現，多數研究表示於急診採高滲鹽水霧化吸入對改善中重度細支氣管炎病童住院率與生理鹽水霧化吸入比較並未有較優的成效，而關於呼吸窘迫變化分數、血氧飽合度、疾病嚴重度及心跳速率指標則是結果較分歧，正反面成效皆有，且高滲鹽水耐受性及安全性佳，未來仍需繼續執行高品質研究以驗證本篇之統整結果。

Acute Bronchiolitis is the leading cause of hospitalization among infants. Nebulized hypertonic saline (HS) in the management of acute bronchiolitis has been shown as an effective treatment. More previous studies explored the effect of nebulized 3%, 5%, or 7% HS for acute bronchiolitis. The aim of the study was to perform a systematic review to summarize the effectiveness of nebulized HS in the emergency department on admission rate in infants with acute bronchiolitis. Literature search was based on The Cochrane Library, PubMed, MEDLINE, ProQuest and Airiti Library. The search was limited to articles published between January, 1997 and July, 2017. Nine randomized controlled trials met the inclusion criteria and were selected for further analysis. Results showed that nebulized HS did not significantly reduce the rate of hospital admissions among infants with moderate to severe acute bronchiolitis who visited the emergency department compared to normal saline. About the effect of respiratory distress change scores, oxygen saturation, clinical severity scores and pulse rate were also inconsistent. The HS treatment was well tolerated and safe. In the future, more rigorous studies should be done to verify these results.