| Objective: To assess the efficacy and safety of different kinds of chest physical therapy(CPT)for children with bronchiolitis,and to provide the basis for the clinical application of chest physical therapy and the choice of scientific research direction.Methods: Clinical trials were searched in databases of Cochrane Library,Ovid,Embase,PubMed,VIP,CBM,CNKI and Wan-fang database,The selection of studies,data extraction and assessment of quality were performed independently by two reviewers.According to the different therapy of this paper is divided into 5 different contrasts: Conventional chest physical therapy(CCPT)vs no CCPT?passive expiratory techniques(PET)vs no PET?PET vs CCPT?PET vs aspiration of sputum(AS)?CCPT vs AS.RevMan 5.3 software perform heterogeneity analysis.Results: fourteen studies were included in the study,with a total of1637 patients.The treatment of this paper mainly included PET?CCPT?AS.Among them,The results of descriptive analysis indicated:(1)after 30 minutes of PET therapy,the clinical score of patients(breathing,breathing,general condition)was significantly lower than that without PET therapy,with statistical significance(P=0.03);(2)PET therapy compared with no PET treatment could significantly reduce the patient's bicarbonate concentration(P<0.05);(3)adverse events were analyzed.PET therapy compared with AS could increase the rate of vomiting(P=0.005)and the incidence of irregular breathing(P=0.0002);(4)other results showed that both PET therapy and CCPT therapy could reduce the incidence of respiratory distress in patients(P=0.001,P<0.001),and there was no statistical significance in the difference between the two treatment(P>0.05).CCPT therapy can shorten The time of wheezes need for remission and The time of pulmonary rale need for remission than NO CCPT therapy,and the difference is statistically significant(P<0.01,P<0.05).There was no significant difference between PET therapy and AS in the rate of artificial ventilation,the intensive care admission and antibiotic treatment(P>0.05).(2)Meta analysis showed that:(1)both PET therapy and CCPT therapy could stabilize the respiratory rate,heart rate and oxygen saturation of the patients with no significant difference(P>0.05);(2)Compared with non CCPT therapy,CCPT therapy could shorten the hospital stay(days)(P<0.00001)?the time of Wheeze need for remission(P= 0.00001),and The time of cough need for remission(P=0.00001).Increase the effective rate(P=0.0002).Conclusions: CCPT therapy can shorten the hospital stay(days)of thepatients with bronchiolitis,relieve the clinical symptoms and pulmonary signs,improve the effective rate,and have no obvious effect on the fluctuation of respiration,heart rate and blood oxygen saturation.PET therapy can significantly reduce the bicarbonate concentration of patients,which can better stabilize patients' breathing,heart rate and blood oxygen saturation.The adverse reactions suggested that PET therapy could increase the risk of vomiting and respiratory irregularity,but only 1 foreign articles reported the bias of the safety analysis of PET therapy.It is suggested that the clinical trials in the future should be as comprehensive as possible,to report the end point and adverse reactions,to standardize the report of the results,and to provide better evidence for the clinical application of physical therapy in the chest and the direction of future research. |
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