Scarfone R J, Loiselle J M, Joffe M D, Mull C C, Stiller S, Thompson K, Gracely E J
Division of Emergency Medicine, Department of Community and Preventive Medicine, MCP Hahnemann School of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Ann Emerg Med. 2000 Dec;36(6):572-8. doi: 10.1067/mem.2000.111060.
Magnesium sulfate has been shown to benefit asthmatic children and adults with poor responses to initial beta(2)-agonist therapy in the emergency department. We sought to determine whether the routine early administration of high-dose magnesium would benefit moderate to severely ill children with acute asthma.
This was a randomized, double-blind, placebo-controlled trial of 54 children 1 to 18 years of age who presented to the ED of a tertiary care children's hospital with a moderate to severe asthma exacerbation. After receiving a nebulized albuterol treatment (0.15 mg/kg) and methylprednisolone (1 mg/kg), patients were randomly assigned to receive either 75 mg/kg of magnesium sulfate (maximum 2.5 g) or placebo. Thereafter, all patients were treated with frequent nebulized albuterol following a structured protocol. The main outcome was degree of improvement as assessed by Pulmonary Index scores over 120 minutes. Secondary outcomes included hospitalization rates and time required to meet discharge criteria.
The mean change in Pulmonary Index score from baseline to 120 minutes was 2.83 for the magnesium group compared with 2.66 for the placebo group (95% confidence interval -1. 24 to 1.60). Eleven (46%) of 24 magnesium-treated patients were hospitalized compared with 16 (53%) of 30 in the placebo group (95% confidence interval -19% to 34%). There were no statistically significant differences between the groups with respect to time required to meet discharge criteria.
The routine administration of high-dose magnesium to moderate to severely ill children with asthma, as an adjunct to initial treatment with albuterol and corticosteroids, was not efficacious.
硫酸镁已被证明对急诊科中对初始β₂受体激动剂治疗反应不佳的哮喘儿童和成人有益。我们试图确定常规早期给予高剂量镁是否会使中重度急性哮喘患儿受益。
这是一项针对54名1至18岁儿童的随机、双盲、安慰剂对照试验，这些儿童因中重度哮喘发作就诊于一家三级护理儿童医院的急诊科。在接受雾化沙丁胺醇治疗（0.15mg/kg）和甲基泼尼松龙（1mg/kg）后，患者被随机分配接受75mg/kg硫酸镁（最大2.5g）或安慰剂。此后，所有患者按照结构化方案接受频繁的雾化沙丁胺醇治疗。主要结局是通过120分钟内的肺指数评分评估的改善程度。次要结局包括住院率和达到出院标准所需的时间。
镁组从基线到第120分钟肺指数评分的平均变化为2.83，而安慰剂组为2.66（95%置信区间为-1.24至1.60）。24名接受镁治疗的患者中有11名（46%）住院，而安慰剂组30名患者中有16名（53%）住院（95%置信区间为-19%至34%）。两组在达到出院标准所需时间方面没有统计学上的显著差异。
对于中重度哮喘患儿，常规给予高剂量镁作为沙丁胺醇和皮质类固醇初始治疗的辅助治疗无效。
