Benito Fernández J, Mintegui Raso S, Sánchez Echaniz J, Vázquez Ronco M A, Pijoan Zubizarreta J I
Unidad de Urgencias de Pediatría. Departamento de Pediatría. Hospital de Cruces. Barakaldo. Vizcaya.
An Esp Pediatr. 2000 Sep;53(3):217-22.
To determine the efficacy of adding ipratropium bromide to nebulized salbutamol in the treatment of children with moderate-to-severe acute asthma attacks.
A total of 102 patients aged between 5 months and 16 years were included in a double-blind randomized trial. All patients were given nebulized salbutamol (0.2 mg/kg) and oral steroids (1 mg/kg). Patients in group A received two doses of nebulized ipratropium bromide (250 mg per dose) and patients in group B were given placebo. Oxygen saturation (SaO2) and a clinical score (heart rate, respiratory rate, dyspnea, retraction of the intercostal spaces, and wheezing) rated from 0 to 5 were measured before treatment and at 120 min.
Patients in both groups showed similar SaO2 values and clinical scores at baseline (group A, 93.05% and 4.45; group B, 92.78% and 4.43) and at 120 min (group A, 94.33% and 2.45; group B, 94.03% and 2.74), but the percentage of patients admitted to the hospital was higher in group B than in group A (53% vs 35%, p = 0.07). In the subset of patients with the most severe attacks (baseline score 5), the clinical score after treatment and the percentage of admissions were significantly higher in group B (n = 22) than in group A (n = 23) (3.32 vs 2.69 and 73% vs 39%, p < 0.05).
Coadministration of ipratropium bromide and repeat doses of nebulized salbutamol produced a small beneficial clinical effect compared with administration of nebulized salbutamol alone. This beneficial effect was related to a decrease in the hospitalization rate, particularly in patients with severe asthma attacks.
确定在雾化沙丁胺醇治疗中加用异丙托溴铵对中重度急性哮喘发作儿童的疗效。
102例年龄在5个月至16岁之间的患者纳入一项双盲随机试验。所有患者均给予雾化沙丁胺醇（0.2mg/kg）和口服类固醇（1mg/kg）。A组患者接受两剂雾化异丙托溴铵（每剂250mg），B组患者给予安慰剂。在治疗前和120分钟时测量氧饱和度（SaO₂）以及从0至5评分的临床评分（心率、呼吸频率、呼吸困难、肋间肌收缩和哮鸣音）。
两组患者在基线时（A组，93.05%和4.45；B组，92.78%和4.43）以及120分钟时（A组，94.33%和2.45；B组，94.03%和2.74）的SaO₂值和临床评分相似，但B组患者的住院率高于A组（53%对35%，p = 0.07）。在发作最严重的患者亚组（基线评分为5）中，B组（n = 22）治疗后的临床评分和住院率百分比显著高于A组（n = 23）（3.32对2.69以及73%对39%，p < 0.05）。
与单独使用雾化沙丁胺醇相比，异丙托溴铵与重复剂量的雾化沙丁胺醇联合使用产生了较小的有益临床效果。这种有益效果与住院率降低有关，尤其是在重度哮喘发作患者中。
