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Ocena uspešnosti dveh metod zdravljenja akutnega bronhiolitisa pri majhnih otrocih
Avtor: Jasna Klen, Tatjana Mrvic
Mentor: Prof. dr. Ciril Kržišnik, dr. med.
Somentor: Mag. Vasilija Macek, dr. med.
IZHODIŠCA. Bronhiolitis je akutna respiratorna bolezen zgodnjega otroštva, ki jo v najvecjem odstotku povzroca respiratorni sincicijski virus.
NAMEN. Zaradi nasprotujocih si mnenj o koristnosti zdravljenja akutnega bronhiolitisa s kortikosteroidi sva izvedli slepo prospektivno študijo, s katero sva skušali oceniti vpliv kortikosteroidne terapije na trajanje in prognozo bolezni pri malih otrocih z blago do zmerno hudo obliko bronhiolitisa.
METODE IN BOLNIKI. V raziskavo je bilo vkljucenih 44 majhnih otrok, starih od 3 do 15 mesecev, ki so bili predhodno zdravi. Otroci so bili nakljucno razporejeni v dve skupini (n = 22), od katerih je ena prejemala kortikosteroide, druga pa ne. Vsakemu otroku sva vzeli anamnesticne podatke o atopicnih boleznih v družini, kajenju matere in oceta, prisotnosti okužb zgomjih dihal v družini, trajanju dojenja in o predhodnih boleznih ter eventuelni terapiji pred sprejemom v bolnišnico. Otroke vsa pregledovali dvakrat dnevno. Merili sva telesno težo, frekvenco dihanja in pulza v spanju, nasicenost Hb z O2 in telesno temperaturo. Ocenjevali sva tudi dihalni napor in avskultatorni izvid. Po odpustu iz bolnisnice so otroci, ki so med hospitalizacijo dobivali kortikosteroide, s to terapijo nadaljevali. Ponovno sva jih pregledali ambulantno cez 14 dni. Starši so medtem doma sami izvajali predpisano terapijo in beležili frekvenco dihanja otrok v spanju.
REZULTATI. V raziskavi sva ugotovili, da ni nobene razlike med obema skupinama otrok v nobenem od parametrov, ki sva jih opazovali. Ugotovili pa sva statisticno pomembno razliko v frekvenci dihanja 3,74 (p < 0,0011 ) med obema skupinama otrok 14 dni po odpustu iz bolnišnice. Stranskih ucinkov kortikosteroidne terapije v opazovanem obdobju ni bilo.
ZAKLJUCKI. Na podlagi najinih rezultatov zato lahko trdiva, da kortikosteroidi lahko skrajšajo prolongiran subklinicen potek bronhiolitisa, da pa ne vplivajo bistveno na težo bolezni v njenem zacetku, niti ne na trajanje hospitalizacije.
[Abstract / English version]
Evaluation of success of two methods in treating acute bronchiolitis in small children
Author: Jasna Klen, Tatjana Mrvic
Mentor: Prof. dr. Ciril Kržišnik, dr. med.
Co-mentor: Mag. Vasilija Macek, dr. med.
INTRODUCTION. Bronchiolitis is an acute respiratory disease of the early childhood. Most cases are caused by respiratory syncytial virus. Although corticosteroids are commonly prescribed in the treatment of bronchiolitis, there is no evidence on the efficacy of these drugs in this disorder.
PURPOSE. Because of different opinions in usefulness of corticosteroid therapy in treatment of acute bronchiolitis we. preformed a blind prospective study with which we tried to establish that corticosteroids do not effect the duration and prognosis of the disease in small children with mild to moderate clinical picture of bronchiolitis. We were also interested in the efficacy and safety for asthma designed corticosteroid therapy in the course of acute bronchiolitis and subsequent post-bronchiolitis wheezing between the two groups.
METHODS AND PATIENTS. 44 infants aged 3-15 months were included in the research. They had not had any previous illnesses. We took anamnestic data of atopic diseases in the family such as: mother and fathers smoking habits, infections in family, duration of breast feeding and possible therapy before the child was admitted to hospital. Infants were randomised into two groups (n = 22). One group received corticosteroids, the other did not. We examined infants two times a day. We measured body weight, rate of respiration and pulse in their sleep, saturation O2 and body temperature. We also rated the effort and auscultatory breathing findings. We examined infants again after 14 days from their discharge from the hospital. During that time the infants received the same therapy as they had in hospital and parents had to measure their breathing frequency during their sleep.
RESULTS. In our research we established that there is no difference between the two groups of infants in any of the parameters which we observed. But we established a statistically significant difference in respiratory rates 3,74 (p < 0,0011 ) between the two groups of infants after they had been discharged from the hospital.
CONCLUSIONS. Thereby as the results of our research show, we could not support the use of corticosteroids in the treatment of mild to moderate clinical picture of acute bronchiolitis. But corticosteroids can shorten a prolonged subclinical course of the disease.