Rodrigo Gustavo J, Rodrigo Carlos, Pollack Charles V, Rowe Brian
Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
Chest. 2003 Mar;123(3):891-6. doi: 10.1378/chest.123.3.891.
To determine the effect of the addition of heliox to standard medical care on the course of acute asthma.
Systematic review of randomized and nonrandomized prospective, controlled trials of children and adults that compared heliox to placebo when used in conjunction with other standard acute treatments.
Pulmonary function tests, hospital admissions, physiologic measures, side effects, and clinical outcomes.
Seven trials were selected for inclusion, with a total of 392 patients with acute asthma. Six studies involved adults, and one study dealt solely with children. The main outcome variable was spirometric measurements (peak expiratory flow or FEV(1)) in six trials. Two studies evaluated the effect of heliox on airways resistance. No significant differences were demonstrated between heliox or oxygen/air groups (standardized mean difference [SMD], - 0.20; 95% confidence interval [CI], - 0.91 to 0.51; p = 0.6). However, the four studies that used heliox to deliver nebulized therapy showed a nonsignificant increase in pulmonary function (SMD, - 0.21; 95% CI, - 0.43 to 0.01; p = 0.06). In two studies of the same subgroup, heliox mixtures produced a significantly greater increase of heart rate than oxygen/air (weighted mean difference, 9.0; 95% CI, 1.27 to 16.8; p = 0.02). However, the four studies that used heliox to deliver nebulized therapy reported a nonsignificant difference in hospital admissions (odds ratio, 1.07; 95% CI, 0.46 to 2.48; p = 0.9). Overall, heliox appears to be safe and well tolerated.
The existing evidence does not provide support for the administration of helium-oxygen mixtures to emergency department patients with moderate-to-severe acute asthma. However, these conclusions are based on between-group comparisons and small studies, and these results should be interpreted with caution.
确定在标准医疗护理中添加氦氧混合气对急性哮喘病程的影响。
对儿童和成人的随机及非随机前瞻性对照试验进行系统评价，这些试验将氦氧混合气与安慰剂在用于其他标准急性治疗时进行比较。
肺功能测试、住院情况、生理指标、副作用及临床结局。
共纳入7项试验，涉及392例急性哮喘患者。6项研究涉及成人，1项研究仅涉及儿童。6项试验中的主要观察变量为肺量计测量值（呼气峰值流速或第1秒用力呼气量[FEV(1)]）。2项研究评估了氦氧混合气对气道阻力的影响。氦氧混合气组与氧气/空气组之间未显示出显著差异（标准化均数差[SMD]，-0.20；95%置信区间[CI]，-0.91至0.51；p = 0.6）。然而，4项使用氦氧混合气进行雾化治疗的研究显示肺功能有非显著增加（SMD，-0.21；95% CI，-0.43至0.01；p = 0.06）。在同一亚组的2项研究中，氦氧混合气体导致心率增加显著大于氧气/空气组（加权均数差，9.0；95% CI，1.27至16.8；p = 0.02）。然而，4项使用氦氧混合气进行雾化治疗的研究报告住院情况无显著差异（比值比，1.07；95% CI，0.46至2.48；p = 0.9）。总体而言，氦氧混合气似乎安全且耐受性良好。
现有证据不支持对中重度急性哮喘的急诊科患者使用氦氧混合气体。然而，这些结论基于组间比较和小型研究，对这些结果的解读应谨慎。
