Rottman S J, Robinson N E, Birnbaum M L
Emergency Medicine Center, University of California-Los Angeles Medical Center 90024, USA.
Prehosp Disaster Med. 1996 Oct-Dec;11(4):280-4. doi: 10.1017/s1049023x00043132.
Although the efficacy of the administration of beta-adrenergic bronchodilators has been demonstrated, the best method available for the delivery of these drugs in the prehospital setting has not been defined. This paper compares the effects of administration of metaproterenol when administered by paramedics using either a metered-dose inhaler (MDI) or a hand-held nebulizer (HHN).
There is no difference in the effects produced in patients suffering from smooth bronchiolar muscle spasm by metaproterenol when delivered either by a standard metered-dose inhaler or with a hand-held nebulizer.
Consecutive prehospital patients complaining of difficulty breathing with clinical evidence of bronchospasm and with a history of asthma, chronic obstructive pulmonary disease, or emphysema who were not in extremis.
Prior to the administration of metaproterenol, a peak expiratory flow rate (PEFR) was obtained. This measurement was repeated five minutes following the conclusion of the administration of metaproterenol. Patients in Burbank, California, received the treatment using a standard metered-dose inhaler, and those in Madison, Wisconsin, received the drug using a hand-held nebulizer. Peak expiratory flow rates were compared using Student's t-tests with Bonferroni's correction. Statistical significance was set at p < 0.05.
Data were collected from 36 consecutive patients by the paramedics of the Burbank Fire Department and from 32 consecutive patients by the paramedics of the Madison Fire Department. For the metered-dose inhaler group, the mean value for peak expiratory flow rate for the pre-treatment test was 95.4 +/- 88.1 l/min, and after treatment was 109.4 +/- 89.3 l/min (p < 0.001). For the hand-held nebulizer group, the mean value for peak expiratory flow rate before the administration of the metaproterenol was 96.1 +/- 76.3 l/min and following the treatment was 149.1 +/- 92.9 l/min (p < 0.001). The mean values for the differences between the control peak expiratory flow rate and the post-treatment peak expiratory flow rate for the metered-dose inhaler group was + 140.0 +/- 27.4 l/min, and for the hand-held nebulizer group was + 53.0 +/- 69.1 l/min (p < 0.003).
In the prehospital setting, the administration of metaproterenol using a hand-held nebulizer is more effective than delivering the drug using a metered-dose inhaler. The hand-held nebulizer is easier to use and delivers a higher dose of the drug than is convenient using the metered-dose inhaler.
尽管β-肾上腺素能支气管扩张剂的给药效果已得到证实，但在院前环境中递送这些药物的最佳可用方法尚未确定。本文比较了护理人员使用定量吸入器（MDI）或手持式雾化器（HHN）给予间羟异丙肾上腺素的效果。
对于患有细支气管平滑肌痉挛的患者，通过标准定量吸入器或手持式雾化器递送间羟异丙肾上腺素所产生的效果没有差异。
连续的院前患者，主诉呼吸困难且有支气管痉挛的临床证据，并有哮喘、慢性阻塞性肺疾病或肺气肿病史，且病情并非危急。
在给予间羟异丙肾上腺素之前，获取呼气峰值流速（PEFR）。在给予间羟异丙肾上腺素结束五分钟后重复该测量。加利福尼亚州伯班克的患者使用标准定量吸入器接受治疗，威斯康星州麦迪逊的患者使用手持式雾化器接受药物治疗。使用Student's t检验并进行Bonferroni校正来比较呼气峰值流速。设定统计学显著性为p < 0.05。
伯班克消防局的护理人员连续收集了36例患者的数据，麦迪逊消防局的护理人员连续收集了32例患者的数据。对于定量吸入器组，治疗前测试的呼气峰值流速平均值为95.4 +/- 88.1升/分钟，治疗后为109.4 +/- 89.3升/分钟（p < 0.001）。对于手持式雾化器组，在给予间羟异丙肾上腺素之前呼气峰值流速平均值为96.1 +/- 76.3升/分钟，治疗后为149.1 +/- 92.9升/分钟（p < 0.001）。定量吸入器组对照呼气峰值流速与治疗后呼气峰值流速差异的平均值为 + 140.0 +/- 27.4升/分钟，手持式雾化器组为 + 53.0 +/- 69.1升/分钟（p < 0.003）。
在院前环境中，使用手持式雾化器给予间羟异丙肾上腺素比使用定量吸入器递送药物更有效。手持式雾化器更易于使用，并且比使用定量吸入器方便递送更高剂量的药物。
