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首页> 外文期刊>Sao Paulo Medical Journal >Interventions for primary (intrinsic) tracheomalacia in children
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Interventions for primary (intrinsic) tracheomalacia in children

机译：儿童原发性（内在）气管软化症的干预措施

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BACKGROUND Tracheomalacia, a disorder of the large airways where the trachea is deformed or malformed during respiration, is commonly seen in tertiary paediatric practice. It is associated with a wide spectrum of respiratory symptoms from life-threatening recurrent apnoea to common respiratory symptoms such as chronic cough and wheeze. Current practice following diagnosis of tracheomalacia includes medical approaches aimed at reducing associated symptoms of tracheomalacia, ventilation modalities of continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP), and surgical approaches aimed at improving the calibre of the airway (airway stenting, aortopexy, tracheopexy). OBJECTIVES To evaluate the efficacy of medical and surgical therapies for children with intrinsic (primary) tracheomalacia. METHODS Search The Cochrane Airways Group searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Group's Specialized Register, Medline and Embase databases. The Cochrane Airways Group performed the latest searches in March 2012. Selection criteria All randomized controlled trials (RCTs) of therapies related to symptoms associated with primary or intrinsic tracheomalacia. Data collection and analysis Two reviewers extracted data from the included study independently and resolved disagreements by consensus. MAIN RESULTS We included one RCT that compared nebulized recombinant human deoxyribonuclease (rhDNase) with placebo in 40 children with airway malacia and a respiratory tract infection. We assessed it to be a RCT with overall low risk of bias. Data analyzed in this review showed that there was no significant difference between groups for the primary outcome of proportion cough-free at two weeks (odds ratio (OR) 1.38; 95% confidence interval (CI) 0.37 to 5.14). However, the mean change in night time cough diary scores significantly favoured the placebo group (mean difference (MD) 1.00; 95% CI 0.17 to 1.83, P = 0.02). The mean change in daytime cough diary scores from baseline was also better in the placebo group compared to those on nebulized rhDNase, but the difference between groups was not statistically significant (MD 0.70; 95% CI -0.19 to 1.59). Other outcomes (dyspnoea, and difficulty in expectorating sputum scores, and lung function tests at two weeks also favoured placebo over nebulized rhDNase but did not reach levels of significance. AUTHORS' CONCLUSIONS There is currently an absence of evidence to support any of the therapies currently utilised for management of intrinsic tracheomalacia. It remains inconclusive whether the use of nebulized rhDNase in children with airway malacia and a respiratory tract infection worsens recovery. It is unlikely that any RCT on surgically based management will ever be available for children with severe life-threatening illness associated with tracheomalacia. For those with less severe disease, RCTs on interventions such as antibiotics and chest physiotherapy are clearly needed. Outcomes of these RCTs should include measurements of the trachea and physiological outcomes in addition to clinical outcomes.
机译：背景技术气管软化症是呼吸道在呼吸过程中变形或畸形的大气道疾病，通常在三级儿科实践中见到。它与多种呼吸道症状有关，从威胁生命的反复呼吸暂停到常见的呼吸道症状，例如慢性咳嗽和喘息。诊断气管软化症后的当前实践包括旨在减轻气管软化症相关症状的医学方法，持续气道正压通气（CPAP）和双水平气道正压通气（BiPAP）的通气方式以及旨在改善气道口径的手术方法（气道支架置入术，主动脉瓣，气管切开术）。目的评估药物和手术疗法对内在性（原发性）气管软化症儿童的疗效。方法搜索Cochrane航空公司小组搜索了Cochrane对照试验中央登记簿（CENTRAL），Cochrane航空公司小组的专门登记簿，Medline和Embase数据库。 Cochrane航空公司小组于2012年3月进行了最新搜索。选择标准所有与原发性或固有性气管软化症相关的治疗方法的所有随机对照试验（RCT）。数据收集与分析两名审稿人独立地从纳入的研究中提取数据，并通过共识解决分歧。主要结果我们纳入了一项RCT，该研究对40例患有气道软化症和呼吸道感染的儿童进行了雾化重组人脱氧核糖核酸酶（rhDNase）和安慰剂的比较。我们将其评估为总体偏倚风险较低的RCT。本评价分析的数据显示，两组在两周无咳嗽的主要结局方面无显着差异（优势比（OR）1.38; 95％置信区间（CI）0.37至5.14）。但是，夜间咳嗽日记得分的平均变化显着偏重于安慰剂组（平均差异（MD）为1.00; 95％CI为0.17至1.83，P = 0.02）。与雾化rhDNase相比，安慰剂组的日间咳嗽日记分数的基线平均变化也更好，但两组之间的差异无统计学意义（MD 0.70; 95％CI -0.19至1.59）。其他结局（呼吸困难，痰排痰困难，以及两周时的肺功能检查）也比安慰剂更优于雾化的rhDNase，但尚未达到显着水平。作者的结论目前尚无证据支持目前的任何疗法用于气管软化症和呼吸道感染的儿童使用雾化的rhDNase是否会恶化康复尚无定论，对于严重威胁生命的儿童，通过外科手术进行的任何RCT都不太可能获得与气管软化症有关的疾病：对于那些病情较轻的人，显然需要采用抗生素和胸部物理疗法等干预措施的RCT，这些RCT的结果应包括对气管和生理结果的测量以及临床结果。

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