国内外儿童毛细支气管炎指南质量评价及治疗意见对比研究  

Comparison Study of Quality Evaluation and Treatment Recommendations of Domestic and Foreign Guidelines for Pediatric Bronchiolitis

作　　者：罗杰烽 潘相丞 杨梦婷 曾力楠[1,2,3] 刘丹 刘峥[1,2,3] 陈婷 贾知军[1,2,3] 成果 张伶俐[1,2,3,4] LUO Jiefeng;PAN Xiangcheng;YANG Mengting;ZENG Linan;LIU Dan;LIU Zheng;CHEN Ting;JIA Zhijun;CHENG Guo;ZHANG Lingli(West China Second University Hospital,Sichuan University,Chengdu,Sichuan,China 610041;NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation,Chengdu,Sichuan,China 610041;Key Laboratory of Birth Defects and Related Diseases of Women and Children,Sichuan University,Ministry of Education,Chengdu,Sichuan,China 610041;Chinese Evidence-Based Medicine Center,West China Hospital,Sichuan University,Chengdu,Sichuan,China 610041)

机构地区：[1]四川大学华西第二医院,四川成都610041 [2]国家药品监督管理局药物制剂体内外相关性技术研究重点实验室,四川成都610041 [3]出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041 [4]四川大学华西医院中国循证医学中心,四川成都610041

出　　处：《中国药业》2023年第20期21-30,共10页China Pharmaceuticals

基　　金：国家卫生健康委员会医疗管理服务指导中心委托课题[2022047]。

摘　　要：目的为我国制订高质量的儿童毛细支气管炎循证指南提供参考。方法计算机检索Embase、Medline、万方、中国知网、维普等数据库及国内外相关指南网站,纳入儿童毛细支气管炎治疗相关指南,检索时限为各数据库自建库起至2021年5月21日。使用AGREEⅡ工具独立评估指南的方法学质量,并比较国内外指南推荐意见的差异。结果共纳入28篇指南,其中国内9篇,国外19篇。我国指南各领域AGREEⅡ平均评分均低于国外指南,得分率较低的领域为严谨性[(30.33±0.13)%]、适用性[(18.98±0.07)%]和独立性[(3.70±0.09)%]。中外指南的非药物治疗推荐意见基本一致,但药物治疗选择(如糖皮质激素、雾化干扰素和肾上腺素)及用药时机存在较大差异。结论我国儿童毛细支气管炎指南的方法学质量较低,在药物治疗方面与国外指南差异较大。且干扰素雾化、中成药和表面活性剂对毛细支气管炎的疗效需要更多大样本、高质量的研究证实。此外,我国应尽快制订高质量的循证指南,为临床实践提供参考。Objective To provide a reference for the formulation of high-quality evidence-based guidelines for pediatric bronchiolitis in China.Methods Relevant guidelines for pediatric bronchiolitis in the Embase,Medline,WanFang,CNKI,VIP databases,domestic and foreign related guideline websites from the inception of each database to May 21,2021 were searched.The methodological quality of the guidelines was independently evaluated by the AGREEⅡtool,and the differences in recommendations between domestic and foreign guidelines were compared.Results A total of twenty-eight guidelines were included,of which nine were domestic and nineteen were foreign.The average AGREEⅡscore in various domains of Chinese guidelines was lower than that of foreign guidelines.The domains with low score rate in Chinese guidelines were rigorousness[(30.33±0.13)%],applicability[(18.98±0.07)%]and independence[(3.70±0.09)%].The non-drug treatment recommendations in Chinese and foreign guidelines were generally consistent,but there were obvious differences in drug treatment selection(such as glucocorticoids,aerosolized interferon and adrenaline)and medication timing.Conclusion The methodological quality of Chinese guidelines for pediatric bronchiolitis is relatively low,and there are great differences in drug treatment compared to foreign guidelines.The efficacy of aerosolized interferon,Chinese patent medicines and surfactant on bronchiolitis needs more high-quality researches with large samples to confirm.In addition,we should formulate high-quality evidence-based guidelines as soon as possible to provide a reference for clinical practice.

关 键 词：循证指南 儿童 毛细支气管炎 AGREEⅡ工具 系统评价 

分 类 号：R97[医药卫生—药品] R562.21[医药卫生—药学]