莫维珠单抗
一种能够增强抗 RSV 活性的单克隆抗体，在降低 RSV 感染住院率方面不劣于帕利珠单抗，并且在降低门诊就诊率方面优于帕利珠单抗。[102]Lagos R, DeVincenzo JP, Muñoz A, et al. Safety and antiviral activity of motavizumab, a respiratory syncytial virus (RSV)-specific humanized monoclonal antibody, when administered to RSV-infected children. Pediatr Infect Dis J. 2009 Sep;28(9):835-7.http://www.ncbi.nlm.nih.gov/pubmed/19636278?tool=bestpractice.com[103]Carbonell-Estrany X, Simões EA, Dagan R, et al. Motavizumab for prophylaxis of respiratory syncytial virus in high-risk children: a noninferiority trial. Pediatrics. 2010 Jan;125(1):e35-51.http://pediatrics.aappublications.org/content/125/1/e35.fullhttp://www.ncbi.nlm.nih.gov/pubmed/20008423?tool=bestpractice.com 在一项对足月婴儿的研究中，与安慰剂相比，莫维珠单抗 (motavizumab) 可减少由于 RSV 哮鸣引起的入院率，但对长期哮鸣无效果。[104]O'Brien KL, Chandran A, Weatherholtz R, et al. Efficacy of motavizumab for the prevention of respiratory syncytial virus disease in healthy Native American infants: a phase 3 randomised double-blind placebo-controlled trial. Lancet Infect Dis. 2015 Dec;15(12):1398-408.http://www.ncbi.nlm.nih.gov/pubmed/26511956?tool=bestpractice.com 药物之间所有不良事件的结果是相似的，莫维珠单抗可能出现更多的皮肤反应，包括过敏反应。美国食品药品监督管理局于 2010 年 8 月拒绝了该药物的许可申请。
表面活性物质
现已报道在患有毛细支气管炎的婴儿中出现表面活性物质缺乏，可能是气道炎症和细胞坏死的结果。在需要机械通气的毛细支气管炎患儿中应用表面活性物质治疗的小型随机对照研究结果显示呼吸力学得到改善，但不影响机械通气的时间。[105]Luchetti M, Ferrero F, Gallini C, et al. Multicenter, randomized, controlled study of porcine surfactant in severe respiratory syncytial virus-induced respiratory failure. Pediatr Crit Care Med. 2002 Jul;3(3):261-8.http://www.ncbi.nlm.nih.gov/pubmed/12780967?tool=bestpractice.com[106]Tibby SM, Hatherill M, Wright SM, et al. Exogenous surfactant supplementation in infants with respiratory syncytial virus bronchiolitis. Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1251-6.http://www.ncbi.nlm.nih.gov/pubmed/11029326?tool=bestpractice.com 推荐毛细支气管炎应用表面活性剂治疗之前，需要进一步的研究支持。[107]Barreira ER, Precioso AR, Bousso A. Pulmonary surfactant in respiratory syncytial virus bronchiolitis: the role in pathogenesis and clinical implications. Pediatr Pulmonol. 2011 May;46(5):415-20.http://www.ncbi.nlm.nih.gov/pubmed/21194166?tool=bestpractice.com[108]Jat KR, Chawla D. Surfactant therapy for bronchiolitis in critically ill infants. Cochrane Database Syst Rev. 2015;(8):CD009194.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009194.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26299681?tool=bestpractice.com
氦-氧
氦氧混合气（heliox）可以降低大、中型气道的阻力，大中型气道内气流呈湍流和密度依赖性。 氦氧混合气体有助于紊流区域转换为层流。 有关小样本的研究显示，应用氦氧混合气治疗婴幼儿毛细支气管炎可以改善临床评分。[109]Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM. Heliox therapy in infants with acute bronchiolitis. Pediatrics. 2002 Jan;109(1):68-73.http://www.ncbi.nlm.nih.gov/pubmed/11773543?tool=bestpractice.com[110]Liet JM, Ducruet T, Gupta V, et al. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2015;(9):CD006915.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006915.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26384333?tool=bestpractice.com[111]Kim IK, Phrampus E, Sikes K, et al. Helium-oxygen therapy for infants with bronchiolitis: a randomized controlled trial. Arch Pediatr Adolesc Med. 2011 Dec;165(12):1115-22.http://www.ncbi.nlm.nih.gov/pubmed/22147778?tool=bestpractice.com 此外，一项大型研究表明除了改善临床评分之外，还可以缩短治疗时间。[112]Chowdhury MM, McKenzie SA, Pearson CC, et al. Heliox therapy in bronchiolitis: phase III multicenter double-blind randomized controlled trial. Pediatrics. 2013 Apr;131(4):661-9.http://pediatrics.aappublications.org/content/131/4/661.longhttp://www.ncbi.nlm.nih.gov/pubmed/23509160?tool=bestpractice.com 然而，只有通过面罩或持续气道正压(鼻导管是无效的)给予氦氧混合气，才能缩短治疗时间。[112]Chowdhury MM, McKenzie SA, Pearson CC, et al. Heliox therapy in bronchiolitis: phase III multicenter double-blind randomized controlled trial. Pediatrics. 2013 Apr;131(4):661-9.http://pediatrics.aappublications.org/content/131/4/661.longhttp://www.ncbi.nlm.nih.gov/pubmed/23509160?tool=bestpractice.com 相反，在一项 meta 分析中，未观察到插管率、入院率或住院时间的降低。[110]Liet JM, Ducruet T, Gupta V, et al. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2015;(9):CD006915.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006915.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26384333?tool=bestpractice.com 由于氦氧混合物的密度依赖性作用，氦的浓度至少需要在50%以上，严重低氧血症的婴幼儿不能使用这种疗法。[7]Ralston SL, Lieberthal AS, Meissner HC, et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502.http://pediatrics.aappublications.org/content/134/5/e1474.longhttp://www.ncbi.nlm.nih.gov/pubmed/25349312?tool=bestpractice.com [ 
]In infants with bronchiolitis, is there randomized controlled trial evidence to support the use of heliox inhalation therapy?https://cochranelibrary.com/cca/doi/10.1002/cca.1173/full显示答案
持续气道正压（CPAP）
几项关于毛细支气管炎的小样本随机临床试验，检测单独持续气道正压通气 (CPAP) 或联合氦氧混合气体的持续气道正压通气。现已报道测定指标（例如临床评分、动脉血二氧化碳分压）有短期改善，但尚未发表足够大样本的临床试验以确定 CPAP 是否能够减少后续的气管插管和机械通气。需要进一步的研究来确定 CPAP 在改善重度毛细支气管炎患者结局方面的确切疗效。[112]Chowdhury MM, McKenzie SA, Pearson CC, et al. Heliox therapy in bronchiolitis: phase III multicenter double-blind randomized controlled trial. Pediatrics. 2013 Apr;131(4):661-9.http://pediatrics.aappublications.org/content/131/4/661.longhttp://www.ncbi.nlm.nih.gov/pubmed/23509160?tool=bestpractice.com[113]Thia LP, McKenzie SA, Blyth TP, et al. Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child. 2008 Jan;93(1):45-7.http://www.ncbi.nlm.nih.gov/pubmed/17344251?tool=bestpractice.com[114]Milési C, Matecki S, Jaber S, et al. 6 cmH(2)O continuous positive airway pressure versus conventional oxygen therapy in severe viral bronchiolitis: a randomized trial. Pediatr Pulmonol. 2013 Jan;48(1):45-51.http://www.ncbi.nlm.nih.gov/pubmed/22431446?tool=bestpractice.com[115]Martinón-Torres F, Rodríguez-Núñez A, Martinón-Sánchez JM. Nasal continuous positive airway pressure with heliox versus air oxygen in infants with acute bronchiolitis: a crossover study. Pediatrics. 2008 May;121(5):e1190-5.http://www.ncbi.nlm.nih.gov/pubmed/18411235?tool=bestpractice.com[116]Donlan M, Fontela PS, Puligandla PS. Use of continuous positive airway pressure (CPAP) in acute viral bronchiolitis: a systematic review. Pediatr Pulmonol. 2011 Aug;46(8):736-46.http://www.ncbi.nlm.nih.gov/pubmed/21618716?tool=bestpractice.com[117]Jat KR, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database Syst Rev. 2015;(1):CD010473.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010473.pub2/abstracthttp://www.ncbi.nlm.nih.gov/pubmed/25563827?tool=bestpractice.com[118]Lal SN, Kaur J, Anthwal P, et al. Nasal continuous positive airway pressure in bronchiolitis: a randomized controlled trial. Indian Pediatr. 2018 Jan 15;55(1):27-30.http://www.ncbi.nlm.nih.gov/pubmed/28952459?tool=bestpractice.com
孟鲁司特
虽然在急性呼吸合胞病毒 (RSV) 感染的治疗方面，孟鲁司特的疗效尚未得到证明，[119]Amirav I, Luder AS, Kruger N, et al. A double-blind, placebo-controlled, randomized trial of montelukast for acute bronchiolitis. Pediatrics. 2008 Dec;122(6):e1249-55.http://www.ncbi.nlm.nih.gov/pubmed/18984650?tool=bestpractice.com 一些临床试验表明该药物可以缓解毛细支气管炎后的喘息。这些数据仍有争议，需要进一步的研究证实。[120]Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132:e341-8.http://pediatrics.aappublications.org/content/132/2/e341.longhttp://www.ncbi.nlm.nih.gov/pubmed/23878043?tool=bestpractice.com[121]Kim CK, Choi J, Kim HB, et al. A randomized intervention of montelukast for post-bronchiolitis: effect on eosinophil degranulation. J Pediatr. 2010 May;156(5):749-54.http://www.ncbi.nlm.nih.gov/pubmed/20171653?tool=bestpractice.com[122]Bisgaard H, Flores-Nunez A, Goh A, et al. Study of montelukast for the treatment of respiratory symptoms of post-respiratory syncytial virus bronchiolitis in children. Am J Resp Crit Care Med. 2008 Oct 15;178(8):854-60.http://www.atsjournals.org/doi/full/10.1164/rccm.200706-910OChttp://www.ncbi.nlm.nih.gov/pubmed/18583576?tool=bestpractice.com[123]Proesmans M, Sauer K, Govaere E, et al. Montelukast does not prevent reactive airway disease in young children hospitalized for RSV bronchiolitis. Acta Paediatr. 2009 Nov;98(11):1830-4.http://www.ncbi.nlm.nih.gov/pubmed/19659463?tool=bestpractice.com[124]Zedan M, Gamil N, El-Assmy M, et al. Montelukast as an episodic modifier for acute viral bronchiolitis: a randomized trial. Allergy Asthma Proc. 2010 Mar-Apr;31(2):147-53.http://www.ncbi.nlm.nih.gov/pubmed/20406596?tool=bestpractice.com[125]Liu F, Ouyang J, Sharma AN, et al. Leukotriene inhibitors for bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2015;(3):CD010636.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010636.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25773054?tool=bestpractice.com[126]Pérez-Gutiérrez F, Otárola-Escobar I, Arenas D. Are leukotriene inhibitors useful for bronchiolitis? Medwave. 2016 Dec 16;16(suppl 5):e6799.http://www.ncbi.nlm.nih.gov/pubmed/28032855?tool=bestpractice.com [ ]How does montelukast affect outcomes in children up to 24 months of age hospitalized with bronchiolitis?https://cochranelibrary.com/cca/doi/10.1002/cca.1032/full显示答案
咖啡因
在较小的婴儿群体中，对咖啡因作用于因毛细支气管炎导致的呼吸暂停的效果进行了研究，虽然安全，但尚未被证明可改变临床结局。一项采用单剂量静脉用咖啡因的双盲、随机、对照临床试验显示，与安慰剂相比，单剂量静脉用咖啡因并未减少呼吸暂停的发作。[127]Alansari K, Toaimah FH, Khalafalla H, et al. Caffeine for the treatment of apnea in bronchiolitis: a randomized trial. J Pediatr. 2016 Oct;177:204-11.e3.http://www.ncbi.nlm.nih.gov/pubmed/27189681?tool=bestpractice.com
高流量鼻导管吸氧治疗
现在已经研究了高流量鼻腔插管治疗，并且发现这是一种安全、耐受性良好的辅助无创通气方式，以减少呼吸功。虽然一些研究显示，与低流量氧相比，该方法对于中度至重度毛细支气管炎患儿的临床结局更好，但另一项研究并未表明，在这种情况下作为一种呼吸支持模式，该方法并不劣于 CPAP。一些研究强调了预防治疗升级为有创机械通气，并证明了高流量治疗优于标准鼻导管氧疗的有益效果。[128]Franklin D, Babl FE, Schlapbach LJ, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med. 2018 Mar 22;378(12):1121-31.www.doi.org/10.1056/NEJMoa1714855http://www.ncbi.nlm.nih.gov/pubmed/29562151?tool=bestpractice.com[129]Slain KN, Shein SL, Rotta AT. The use of high-flow nasal cannula in the pediatric emergency department. J Pediatr (Rio J). 2017 Nov - Dec;93(suppl 1):36-45.www.doi.org/10.1016/j.jped.2017.06.006http://www.ncbi.nlm.nih.gov/pubmed/28818509?tool=bestpractice.com 需要更多的研究来证明在重症监护室和普通病房中常规使用该方法的合理性。[130]Beggs S, Wong ZH, Kaul S, et al. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev. 2014;(1):CD009609.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009609.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/24442856?tool=bestpractice.com[131]Milani GP, Plebani AM, Arturi E, et al. Using a high-flow nasal cannula provided superior results to low-flow oxygen delivery in moderate to severe bronchiolitis. Acta Paediatr. 2016 Aug;105(8):e368-72.http://www.ncbi.nlm.nih.gov/pubmed/27102726?tool=bestpractice.com[132]Mikalsen IB, Davis P, Øymar K. High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med. 2016 Jul 12;24:93.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4942966/http://www.ncbi.nlm.nih.gov/pubmed/27405336?tool=bestpractice.com[133]Wegner A, Cespedes F, Godoy M, et al. High flow nasal cannula in infants: Experience in a critical patient unit. Rev Chil Pediatr. 2015 May-Jun;86(3):173-81.http://www.ncbi.nlm.nih.gov/pubmed/26363858?tool=bestpractice.com[134]Wu SH, Chen XQ, Kong X, et al. Characteristics of respiratory syncytial virus-induced bronchiolitis co-infection with Mycoplasma pneumoniae and add-on therapy with montelukast. World J Pediatr. 2016 Feb;12(1):88-95.http://www.ncbi.nlm.nih.gov/pubmed/25846070?tool=bestpractice.com[135]Milési C, Essouri S, Pouyau R, et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med. 2017 Feb;43(2):209-16.http://www.ncbi.nlm.nih.gov/pubmed/28124736?tool=bestpractice.com[136]Kepreotes E, Whitehead B, Attia J, et al. High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet. 2017 Mar 4;389(10072):930-9.http://www.ncbi.nlm.nih.gov/pubmed/28161016?tool=bestpractice.com
硫酸锌
50 名患有急性毛细支气管炎的婴儿在普通病房接受硫酸锌治疗，缩短了住院时间，但是治疗组和对照组的住院时间均长于大多数其他研究。[137]Mahyar A, Ayazi P, Ahmadi NK, et al. Zinc sulphate for acute bronchiolitis: a double-blind placebo-controlled trial. Infez Med. 2016 Dec 1;24(4):331-6.http://www.ncbi.nlm.nih.gov/pubmed/28011970?tool=bestpractice.com
吸入用一氧化氮 (iNO)
在一项研究的事后分析中，旨在评估 21 例患有毛细支气管炎的婴儿接受 iNO 的安全性和耐受性，与未接受 iNO 治疗的婴儿相比，住院超过 24 小时且接受 iNO 治疗的婴儿住院时间较短，而对于 24 小时内出院的患者，两组的住院时间没有差异。[138]Tal A, Greenberg D, Av-Gay Y, et al. Nitric oxide inhalations in bronchiolitis: a pilot, randomized, double-blinded, controlled trial. Pediatr Pulmonol. 2018 Jan;53(1):95-102.www.doi.org/10.1002/ppul.23905http://www.ncbi.nlm.nih.gov/pubmed/29178284?tool=bestpractice.com
阿奇霉素
在评估减少毛细支气管炎后复发性喘息的干预措施时，一组检查了上气道微生物组，结果显示，在急性疾病期间给 19 名婴儿服用阿奇霉素两周后，在接下来的 12 个月内复发性喘息减少了 50%。[139]Zhou Y, Bacharier LB, Isaacson-Schmid M, et al. Azithromycin therapy during respiratory syncytial virus bronchiolitis: upper airway microbiome alterations and subsequent recurrent wheeze. J Allergy Clin Immunol. 2016 Oct;138(4):1215-19.www.doi.org/10.1016/j.jaci.2016.03.054http://www.ncbi.nlm.nih.gov/pubmed/27339392?tool=bestpractice.com 这些研究人员发现，在治疗结束时，无论治疗组如何，复发性喘息与鼻腔灌洗液样品中卡他莫拉菌的含量较高有关。
臭灵丹 (Laggera pterodonta)
对 67 名 3 至 24 月龄的急性毛细支气管炎患儿使用臭灵丹 (Laggera pterodonta；一种传统中药），与对照组相比，在 96 小时和 120 小时达到出院标准的儿童比例更高。[140]Shang X, Liabsuetrakul T, Sangsupawanich P, et al. Efficacy and safety of Laggera pterodonta in children 3-24 months with acute bronchiolitis: a randomized controlled trial. Clin Respir J. 2017 May;11(3):296-304.http://www.ncbi.nlm.nih.gov/pubmed/26076757?tool=bestpractice.com
