从实践提炼共识，以共识指导实践：《儿童呼吸道合胞病毒感染临床诊治中国专家共识（2023年版）》解读

doi:10.12372/jcp.2024.24e0523

摘要/Abstract

摘要：

呼吸道合胞病毒（RSV）感染是全球卫生问题，对5岁以下儿童的健康造成了严重的威胁。本文紧扣《儿童呼吸道合胞病毒感染临床诊治中国专家共识（2023年版）》，围绕RSV病原学诊断的窗口期、RSV迟发性重症、RSV支持治疗等关键问题进行深度解读。

关键词: 呼吸道合胞病毒, 病原学诊断, 迟发性重症, 支持治疗

Abstract:

Respiratory syncytial virus (RSV) infection is a global health issue that poses a serious threat to the health of children under the age of 5. This article closely follows the “Chinese expert consensus on the clinical diagnosis and treatment of respiratory syncytial virus infection in children (2023 edition)”, and makes an in-depth interpretation of key issues such as the window period for RSV pathogenic diagnosis, late-onset severe disease of RSV, and supportive treatment of RSV.

Key words: respiratory syncytial virus, etiological diagnosis, late-onset severe disease, supportive treatment

黄丽素, 林罗娜, 张贤丽. 从实践提炼共识，以共识指导实践：《儿童呼吸道合胞病毒感染临床诊治中国专家共识（2023年版）》解读[J]. 临床儿科杂志, 2024, 42(6): 553-557.

HUANG Lisu, LIN Luona, ZHANG Xianli. From practice to consensus, from consensus to practice: interpretation of Chinese expert consensus on the diagnosis and treatment of respiratory syncytial virus infections in children (2023 edition)[J]. Journal of Clinical Pediatrics, 2024, 42(6): 553-557.

图/表 1

参考文献 28

[1]	国家儿童健康与疾病临床医学研究中心, 中华医学会儿科学分会感染学组, 上海市医学会感染病分会, 等. 儿童呼吸道合胞病毒感染临床诊治中国专家共识(2023年版)[J]. 临床儿科杂志, 2024, 42(1): 1-14.
[2]	Zhang XL, Zhang X, Hua W, et al. Expert consensus on the diagnosis, treatment, and prevention of respiratory syncytial virus infections in children[J]. World J Pediatr, 2024, 20(1): 11-25.
[3]	Meslé MMI, Sinnathamby M, Mook P, et al. Seasonal and inter-seasonal RSV activity in the European Region during the COVID-19 pandemic from autumn 2020 to summer 2022[J]. Influenza Other Respir Viruses, 2023, 17(11): e13219.
[4]	Reicherz F, Xu RY, Abu-Raya B, et al. Waning immunity against respiratory syncytial virus during the coronavirus disease 2019 pandemic[J]. J Infect Dis, 2022, 226(12): 2064-2068.
[5]	Hamid S, Winn A, Parikh R, et al. Seasonality of respiratory syncytial virus - United States, 2017-2023[J]. MMWR Morb Mortal Wkly Rep, 2023, 72(14): 355-361.
[6]	Adams G, Moreno GK, Petros BA, et al. Viral lineages in the 2022 RSV surge in the United States[J]. N Engl J Med, 2023, 388(14): 1335-1337.
[7]	李洋, 李颖, 杜慧, 等. 2020—2023年湖北省某儿童医院呼吸道合胞病毒的临床流行病学特征分析[J]. 中华预防医学杂志, 2024, 58(2): 213-218.
[8]	孙宇, 朱汝南, 王芳, 等. 2023年春季北京地区儿童急性呼吸道感染病原谱分析[J]. 中华儿科杂志, 2024, 62(2): 159-164.
[9]	Fretzayas A, Moustaki M. Etiology and clinical features of viral bronchiolitis in infancy[J]. World J Pediatr, 2017, 13(4): 293-299. doi: 10.1007/s12519-017-0031-8 pmid: 28470580
[10]	Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis[J]. Lancet, 2017, 389(10065): 211-224. doi: S0140-6736(16)30951-5 pmid: 27549684
[11]	Meissner HC. Viral Bronchiolitis in Children[J]. N Engl J Med, 2016, 374(1): 62-72.
[12]	Oakley E, Brys T, Borland M, et al. Medication use in infants admitted with bronchiolitis[J]. Emerg Med Australas, 2018, 30(3): 389-397. doi: 10.1111/1742-6723.12968 pmid: 29573212
[13]	Farley R, Spurling GK, Eriksson L, et al. Antibiotics for bronchiolitis in children under two years of age[J]. Cochrane Database Syst Rev, 2014, 2014(10): CD005189.
[14]	Li Y, Wang X, Blau DM, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis[J]. Lancet, 2022, 399(10340): 2047-2064. doi: 10.1016/S0140-6736(22)00478-0 pmid: 35598608
[15]	Kang JM, Lee J, Kim YK, et al. Pediatric intensive care unit admission due to respiratory syncytial virus: retrospective multicenter study[J]. Pediatr Int, 2019, 61(7): 688-696.
[16]	《中华儿科杂志》编辑委员会, 中华医学会儿科学分会呼吸学组. 毛细支气管炎诊断、治疗与预防专家共识(2014年版)[J]. 中华儿科杂志, 2015, 53(3): 168-171.
[17]	Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis[J]. Pediatrics, 2014, 134(5): e1474-e1502.
[18]	Alharbi AS, Alqwaiee M, Al-Hindi MY, et al. Bronchiolitis in children: the Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO)[J]. Ann Thorac Med, 2018, 13(3): 127-143. doi: 10.4103/atm.ATM_60_18 pmid: 30123331
[19]	Dysart K, Miller TL, Wolfson MR, et al. Research in high flow therapy: mechanisms of action[J]. Respir Med, 2009, 103(10): 1400-1405. doi: 10.1016/j.rmed.2009.04.007 pmid: 19467849
[20]	Sinha IP, McBride AKS, Smith R, et al. CPAP and high-flow nasal cannula oxygen in bronchiolitis[J]. Chest, 2015, 148(3): 810-823. doi: S0012-3692(15)50661-2 pmid: 25836649
[21]	Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis[J]. Cochrane Database Syst Rev, 2014, 2014(6): CD001266.
[22]	Cai Z, Lin Y, Liang J. Efficacy of salbutamol in the treatment of infants with bronchiolitis: A meta-analysis of 13 studies[J]. Medicine (Baltimore), 2020, 99(4): e18657.
[23]	Midulla F, Nenna R, Scagnolari C, et al. How respiratory syncytial virus genotypes influence the clinical course in infants hospitalized for bronchiolitis[J]. J Infect Dis, 2019, 219(4): 526-534. doi: 10.1093/infdis/jiy496 pmid: 30204889
[24]	Lin J, Zhang Y, Song A, et al. Exploring the appropriate dose of nebulized hypertonic saline for bronchiolitis: a dose-response meta-analysis[J]. J Investig Med, 2022, 70(1): 46-54.
[25]	Hsieh CW, Chen C, Su HC, et al. Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials[J]. BMC Pediatr, 2020, 20(1): 434.
[26]	Mandelberg A, Amirav I. Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale[J]. Pediatr Pulmonol, 2010, 45(1): 36-40.
[27]	Wang X, Li Y, Shi T, et al. Global disease burden of and risk factors for acute lower respiratory infections caused by respiratory syncytial virus in preterm infants and young children in 2019: a systematic review and meta-analysis of aggregated and individual participant data[J]. Lancet, 2024, 403(10433): 1241-1253.
[28]	Wu N, Zhang J, Shen Y, et al. A potential bivalent mRNA vaccine candidate protects against both RSV and SARS-CoV-2 infections[J]. Mol Ther, 2024, 32(4): 1033-1047.

项目	轻度	中度	重度
喂养量	正常	下降至正常一半	下降至正常一半以上
呼吸频率	正常或略快	>60次/min	>70次/min
胸壁吸气性三凹征	无	肋间隙凹陷较明显	肋间隙凹陷较明显
鼻翼扇动或呻吟	无	无	有
血氧饱和度	>92%	88%~92%	<88%
精神状态	正常	轻微或间断烦躁、易激惹	极度烦躁不安、嗜睡、昏迷