Mitra A
Specialist Register Respiratory Paediatrics, Tayside Institute of Child Health, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Minerva Pediatr. 2003 Aug;55(4):369-75.
Intravenous aminophylline is effective in children with acute asthma and was the bronchodilator of choice for many years. However, with the advent of inhaled b agonists and anticholinergic agents an alternative, less invasive, therapeutic strategy is currently available. If children with acute asthma fail to respond to inhaled therapy clinicians may consider aminophylline a controversial treatment. The published evidence on whether aminophylline produces further beneficial effect in children already receiving inhaled therapy for acute asthma is reviewed in this paper. The published randomised controlled trials comparing aminophylline with placebo are of good methodological quality, although the numbers of children in many of the studies are small. Trial outcomes included lung function (FEV1 and PEF) and clinical scoring of asthma severity. Aminophylline improved percentage predicted FEV1 by 6 hours, and this effect was maintained for 24 hours. Improvements were also seen in clinical asthma severity scores at 6 hours. Despite improvements in lung function and asthma severity, there was no reduction in hospital stay or the number of nebulisers required. The main side effect of aminophylline therapy was an increased incidence of vomiting. In conclusion, the addition of intravenous aminophylline should be considered early in the treatment of children hospitalised with acute severe asthma with suboptimal response to the initial inhaled bronchodilator therapy. Further research should be carried out to examine whether intravenous aminophylline may have a beneficial effect in other settings such as intensive care to determine if it may reduce intubation and ventilation rates.
静脉注射氨茶碱对急性哮喘患儿有效，多年来一直是首选的支气管扩张剂。然而，随着吸入性β激动剂和抗胆碱能药物的出现，目前有了一种替代性的、侵入性较小的治疗策略。如果急性哮喘患儿对吸入治疗无反应，临床医生可能会认为氨茶碱是一种有争议的治疗方法。本文综述了关于氨茶碱对已接受急性哮喘吸入治疗的患儿是否产生进一步有益作用的已发表证据。尽管许多研究中的儿童数量较少，但已发表的比较氨茶碱与安慰剂的随机对照试验在方法学质量上较好。试验结果包括肺功能（第一秒用力呼气容积和呼气峰流速）和哮喘严重程度的临床评分。氨茶碱在6小时时使预计第一秒用力呼气容积百分比提高，且这种效果持续24小时。在6小时时哮喘严重程度临床评分也有改善。尽管肺功能和哮喘严重程度有所改善，但住院时间或所需雾化器数量并未减少。氨茶碱治疗的主要副作用是呕吐发生率增加。总之，对于因急性重度哮喘住院且对初始吸入支气管扩张剂治疗反应欠佳的患儿，应在治疗早期考虑加用静脉注射氨茶碱。应开展进一步研究，以检验静脉注射氨茶碱在其他环境（如重症监护）中是否可能产生有益作用，以确定其是否可降低插管和通气率。
