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Title 重症RSウイルス感染症の病態と治療
Subtitle 特集 アップデート, RSウイルスとRSウイルス感染症
Authors 植田穣
Authors (kana)
Organization 埼玉医科大学病院 小児科
Journal 臨床とウイルス
Volume 51
Number 2
Page 102-110
Year/Month 2023 / 5
Article 報告
Publisher 日本臨床ウイルス学会
Abstract 〔論文要旨〕小児において重症RSウイルス感染症を診断するための明確な定義はないため, 呼吸窮迫症状や, バイタルサイン, 経口摂取量などから重症度を経時的に評価する. 治療は酸素療法や補液, 薬物療法, 肺理学療法などの対症療法が中心であり, さらに呼吸状態が悪化した場合は, 高流量酸素療法や人工呼吸管理などの呼吸サポートを行う. 本稿では呼吸状態の評価法や治療について, エビデンスと一部経験をもとに有用性を評価した. 治療は対症療法が中心であり, 現時点でのメタ解析やシステマティックレビューでは明らかな効果が示されていないものもあるが, その治療のすべてを否定するものではなく, 症例ごとに病態を評価し, 最適と考える治療を提供するべきである. また, 小児の呼吸障害は進行が早いため, 努力性呼吸がみられた際はすみやかに呼吸サポートを検討・導入すること, 治療開始後に呼吸状態が増悪する, もしくは改善しない場合は, 遅滞なく次の治療ステップに移行することの2点が大切である.
Practice 臨床医学：内科系
Keywords 急性呼吸障害, 細気管支炎, 呼吸窮迫症状, 呼吸サポート, acute respiratory failure, bronchiolitis, acute respiratory distress, respiratory support

English

Title Pathophysiology and treatment of severe RS virus infection
Subtitle
Authors Yutaka UEDA
Authors (kana)
Organization Saitama Medical University Hospital, Department of Pediatrics
Journal Clinical Virology
Volume 51
Number 2
Page 102-110
Year/Month 2023 / 5
Article Report
Publisher Japanese Society of Clinical Virology
Abstract Since there is no clear definition for diagnosing severe RS virus infection in children, the severity is assessed over time based on respiratory distress symptoms, vital signs, and oral intake. Treatment mainly includes symptomatic treatment such as oxygen therapy, fluid replacement, drug therapy, and pulmonary physical therapy, and if the respiratory condition worsens, respiratory support such as high-flow oxygen therapy and artificial respiration management is provided. In this study, we evaluated the usefulness of respiratory status assessment methods and treatments based on evidence and experience. Although meta-analyses and systematic reviews have not shown clear effects, we do not rule out the usefulness of any treatments, and we should evaluate the pathology of each patient and provide treatment that is considered optimal. In addition, since respiratory disorders in children progress rapidly, respiratory support should be promptly provided when retractive breathing or groan is observed, and if the respiratory condition worsens or does not improve after starting treatment, it is important to progress to the next treatment step without delay.
Practice Clinical internal medicine
Keywords acute respiratory failure, bronchiolitis, acute respiratory distress, respiratory support
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