虽然多数患儿的哮吼为轻度和短期自限性疾病,但有证据表明儿童和家庭承受了一定的压力和干扰。[100]Johnson D, Williamson J. Croup: duration of symptoms and impact on family functioning. Pediatr Res. 2001;49:83A.
轻度
无需治疗的自限性疾病,但地塞米松治疗可缩短恢复时间。
中度
预后尚可。虽然阻塞症状令人感到恐惧,但是症状消退后并无显著的并发症。
重度
皮质类固醇成为标准治疗方法之前,严重哮吼儿童接受气管内插管的可能性高 5 倍,[50]Kairys SW, Marsh-Olmstead EM, O'Connor GT. Steroid treatment of laryngotracheitis: a meta-analysis of the evidence from randomized trials. Pediatrics. 1989;83:683-693.http://www.ncbi.nlm.nih.gov/pubmed/2654865?tool=bestpractice.com 维持插管的时间延长 30%。[51]Tibballs J, Shann FA, Landau LI. Placebo-controlled trial of prednisolone in children intubated for croup. Lancet. 1992;340:745-748.http://www.ncbi.nlm.nih.gov/pubmed/1356176?tool=bestpractice.com 引入常规皮质类固醇治疗后,儿童插管数量大大减少,减少气管插管率和插管时间:有高质量的证据显示,皮质类固醇治疗能减少气管插管率和插管时间。针对 10 项随机对照试验的 meta 分析(纳入 1286 名患严重哮吼且濒临呼吸衰竭的儿童)显示,接受皮质类固醇治疗患儿的气管内插管率减少 5 倍。[50]Kairys SW, Marsh-Olmstead EM, O'Connor GT. Steroid treatment of laryngotracheitis: a meta-analysis of the evidence from randomized trials. Pediatrics. 1989;83:683-693.http://www.ncbi.nlm.nih.gov/pubmed/2654865?tool=bestpractice.com 另一项研究发现,与使用安慰剂的患儿相比,在接受气管插管和皮质类固醇联合治疗的 70 名严重哮吼患儿中,插管时间减少 1/3,而且再次插管的风险减少了 7 倍。[51]Tibballs J, Shann FA, Landau LI. Placebo-controlled trial of prednisolone in children intubated for croup. Lancet. 1992;340:745-748.http://www.ncbi.nlm.nih.gov/pubmed/1356176?tool=bestpractice.com系统评价或者受试者>200名的随机对照临床试验(RCT)。 ICU 入住的天数减少,住院时间也有所缩短。[54]Geelhoed GC. Sixteen years of croup in a Western Australian teaching hospital: effects of routine steroid treatment. Ann Emerg Med. 1996;28:621-626.http://www.ncbi.nlm.nih.gov/pubmed/8953950?tool=bestpractice.com 地塞米松和雾化吸入肾上腺素联合治疗成为标准治疗后,重度哮吼的预后评估。
濒临呼吸衰竭。
非常罕见,仅 1%-3% 需要插管。[46]Sofer S, Dagan R, Tal A. The need for intubation in serious upper respiratory tract infection in pediatric patients (a retrospective study). Infection. 1991;19:131-134.http://www.ncbi.nlm.nih.gov/pubmed/1889864?tool=bestpractice.com[47]Sendi K, Crysdale WS, Yoo J. Tracheitis: outcome of 1,700 cases presenting to the emergency department during two years. J Otolaryngol. 1992;21:20-24.http://www.ncbi.nlm.nih.gov/pubmed/1564745?tool=bestpractice.com[48]Tan AK, Manoukian JJ. Hospitalized croup (bacterial and viral): the role of rigid endoscopy. J Otolaryngol. 1992:21;48-53.http://www.ncbi.nlm.nih.gov/pubmed/1564750?tool=bestpractice.com[49]Dawson KP, Mogridge N, Downward G. Severe acute laryngotracheitis in Christchurch 1980-90. N Z Med J. 1991;104:374-375.http://www.ncbi.nlm.nih.gov/pubmed/1923075?tool=bestpractice.com