蜂蜜:孩童止咳替代良药


  【24drs.com】根据刊载于8月6日小儿科期刊一篇安慰剂控制、随机双盲试验结果,对于上呼吸道感染孩童的夜咳,蜂蜜比安慰剂更有效。
  
  世界卫生组织建议,蜂蜜可作为上呼吸道感染孩童的夜咳治疗方式,不过,之前的研究不是只有检测一种蜂蜜,就是没有做到双盲。
  
  这次的研究,对于上呼吸道感染且有夜咳的孩童,依据双盲随机设计,睡前30分钟给予三种厂牌蜂蜜之一或安慰剂;初级结果是依据家长调查之咳嗽频率的主观改变,次级结果测量包括咳嗽严重度改变、咳嗽对孩童和家长睡眠的影响、介入前与介入后之调查分数的总分。
  
  以色列Petach Tikva小儿科门诊社区诊所Herman Avner Cohen医师等人,比较了介入前后、每个治疗组的症状分数,发现有使用蜂蜜的三组病患都比安慰剂组有显著改善,不同种类的蜂蜜之间则无显著差异。
  
  研究结果显示,对于夜咳、孩童睡眠与家长睡眠,这三种蜂蜜(桉树、柑橘、丹参)都比安慰剂有效。
  
  研究者纳入了在2009年1月至2009年12月间,在6处一般小儿科社区诊所就诊的300名1-5岁上呼吸道感染孩童,如果有上呼吸道感染引起的夜咳即纳入研究,如果有气喘、肺炎、喉咙气管支气管炎、鼻窦炎,和/或过敏性鼻炎等症状的孩童则排除,在24小时内有使用咳嗽或感冒药或蜂蜜的病患也排除。
  
  要求家长评估孩童的出现天数、何时不再给药,然后,在睡前给予单一剂量、10 g的桉树、柑橘、丹参蜂蜜或安慰剂(silan date萃取物)之后隔天再度询问。介入前和介入后的主观评估,使用的是有关孩童咳嗽和睡眠困难的5项Likert量表问卷,只有在介入前问卷、三个有关夜咳与睡眠质量问题中,至少两题家长排序严重度至少3分(7分量表)的孩童被纳入。
  
  纳入的300名病患中,270人(89.7%)完成单一夜晚的研究;孩童年龄中位数为29个月(范围为12 – 71个月),各治疗组之间的年龄没有显著差异,全部四组的症状严重度也相似。
  
  5个人有副作用事件报告,包括胃痛、恶心与呕吐,各组并无显著差异。
  
  作者们表示,研究限制包括,调查的主观本质,介入期间仅有单一剂量。此外,测量到的某些改善可能是因为上呼吸道感染的自然病程变化-随著支持疗法和时间的改善。
  
  Cohen医师等人表示,根据我们的研究结果,蜂蜜可作为1岁以上孩童的替代疗法。他们结论指出,蜂蜜可以是上呼吸道孩童夜咳与睡眠困难的可行疗法。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6901&x_classno=0&x_chkdelpoint=Y
  

Honey: A Sweet Alternative for Treating Cough in Children

By Jennifer Garcia
Medscape Medical News

August 6, 2012 — Honey is more effective than a placebo in controlling nighttime cough in children with upper respiratory infections (URI), according to the results from a new randomized placebo-controlled, double-blind trial. The results were published online August 6 in Pediatrics.

The World Health Organization recommends honey as a nighttime treatment for coughing in young children with URIs. However, prior studies either tested only a single type of honey or were not blinded.

In the current study, children with URIs and nocturnal cough were given either 1 of 3 different honey products or a placebo 30 minutes before bedtime, based on a double-blind randomization plan. The primary outcome evaluated was a subjective change in cough frequency, based on parent surveys. Secondary outcomes measured included a change in cough severity, the effect of the cough on sleep for both the child and the parent, and the combined score on the pre- and postintervention surveys.

Herman Avner Cohen, MD, from the Pediatric Ambulatory Community Clinic, Petach Tikva, Israel, and colleagues compared symptom scores for each treatment group before and after the intervention and found that patients in all 3 honey groups demonstrated significant improvement compared with patients treated with placebo. There were no significant differences among the different types of honey.

"The results of this study demonstrate that each of the 3 types of honey (eucalyptus, citrus, and labiatae) was more effective than the placebo for the treatment of all of the outcomes related to nocturnal cough, child sleep, and parental sleep," the authors write.

The researchers enrolled 300 children with URIs, aged 1 to 5 years, who were seen at 1 of 6 general pediatric community clinics between January 2009 and December 2009. Patients were eligible if they had a nocturnal cough attributed to the URI. Children were excluded if they had symptoms of asthma, pneumonia, laryngotracheobronchitis, sinusitis, and/or allergic rhinitis. Patients who used any cough or cold medication or honey in the previous 24 hours were also excluded.

Parents were asked to evaluate the children the day of presentation, when no medication had been given, and then again the day after a single dose of 10 g of eucalyptus honey, citrus honey, labiatae honey, or placebo (silan date extract) had been administered before bedtime. Pre- and postintervention subjective assessments were obtained using a 5-item Likert-scale questionnaire regarding the child's cough and sleep difficulty. Only those children whose parents rated severity as at least a 3 (on a 7-point scale) for at least 2 of the 3 questions related to nocturnal cough and sleep quality on the preintervention questionnaire were included.

Of the 300 patients enrolled, 270 (89.7%) completed the single-night study. The median age of these children was 29 months (range, 12 - 71 months). There was no significant age difference among the treatment groups. Symptom severity was also similar among all 4 treatment groups.

Adverse events were reported for 5 patients and included stomachache, nausea, and vomiting and were not significantly different between the groups.

The authors acknowledge the limitations of the study, including the subjective nature of the survey and the fact that the intervention period was limited to a single dose. In addition, they note that some of the improvement measured may be attributed to the natural progression of URIs, which may improve with supportive care and time.

"On the basis of our findings, honey can be offered as an alternate treatment to children >1 year of age," note Dr. Cohen and colleagues.

"Honey may be a preferable treatment of cough and sleep difficulties associated with childhood URI," they conclude.

Funding for this study was provided by a research grant from the Israel Ambulatory Pediatric Association, Materna Infant Nutrition Research Institute, and the Honey Board of Israel. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 6, 2012.

    
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