Alario A J, Lewander W J, Dennehy P, Seifer R, Mansell A L
Department of Pediatrics, Brown University School of Medicine, Providence, RI.
Am J Dis Child. 1992 Apr;146(4):412-8. doi: 10.1001/archpedi.1992.02160160032008.
The benefit of beta-adrenergic agonists in the treatment of acutely wheezing infants and young children has not been well documented in the outpatient setting. To determine the efficacy of nebulized metaproterenol sulfate, 74 children aged 36 months or younger with acute wheezing participated in a double-masked, randomized, placebo-controlled clinical trial. Children received nebulized metaproterenol, either as an initial treatment or after a control treatment with normal saline solution. At baseline and 20 minutes after each treatment, an assessment was made that included measurements of heart rate, respiratory rate, oxygen saturation, and clinical variables related to respiratory compromise with the use of a standardized respiratory distress index (RDI). Children who received saline solution as initial therapy had no significant differences from baseline in any of the assessment measures. After metaproterenol therapy, children demonstrated an increase in heart rate ([mean +/- SD] 147 +/- 14 beats per minute vs 153 +/- 16 beats per minute), a decrease in respirations (50/min +/- 5/min vs 45/min +/- 7/min), improvement (lower scores) on the RDI (24 +/- 4 vs 15 +/- 2), and an increase in oxygen saturation (94.1% +/- 2.7% vs 95.3% +/- 3.0%). Patients aged 12 months or younger (n = 37) benefited from metaproterenol treatment (improvement in respiratory rate and RDI) but not to the same degree as children aged 24 months or older (n = 23) (improvement in respiratory rate, RDI, and oxygen saturation). Compared with assessments made before metaproterenol treatment, patients with respiratory syncytial virus infection (n = 21) had improvement in respirations (52/min +/- 7/min vs 45/min +/- 6/min) and RDI scores (22 +/- 4 vs 14 +/- 3). Based on a priori criteria (reduction in a premedication respiratory rate of 20% and an RDI score of 50%), responders to metaproterenol therapy included 45% of the entire sample and, respectively, 40% of those aged 12 months or younger, 52% of those aged 24 months or older, and 48% of patients who tested positive for respiratory syncytial virus. Although there appears to be an age-dependent degree of response, metaproterenol is effective in relieving the respiratory distress of young acutely wheezing children, including those with documented respiratory syncytial virus bronchiolitis.
β-肾上腺素能激动剂在门诊环境中治疗急性喘息婴幼儿的益处尚未得到充分记录。为了确定雾化硫酸间羟异丙肾上腺素的疗效，74名36个月及以下的急性喘息儿童参与了一项双盲、随机、安慰剂对照临床试验。儿童接受雾化硫酸间羟异丙肾上腺素治疗，或作为初始治疗，或在使用生理盐水进行对照治疗后使用。在基线时以及每次治疗后20分钟，进行评估，包括测量心率、呼吸频率、血氧饱和度，以及使用标准化呼吸窘迫指数（RDI）测量与呼吸功能不全相关的临床变量。接受生理盐水作为初始治疗的儿童在任何评估指标上与基线相比均无显著差异。硫酸间羟异丙肾上腺素治疗后，儿童心率增加（[平均值±标准差]每分钟147±14次 vs 每分钟153±16次），呼吸频率降低（50次/分钟±5次/分钟 vs 45次/分钟±7次/分钟），RDI评分改善（得分更低）（24±4 vs 15±2），血氧饱和度增加（94.1%±2.7% vs 95.3%±3.0%）。12个月及以下的患者（n = 37）从硫酸间羟异丙肾上腺素治疗中获益（呼吸频率和RDI改善），但获益程度不如24个月及以上的儿童（n = 23）（呼吸频率、RDI和血氧饱和度均改善）。与硫酸间羟异丙肾上腺素治疗前的评估相比，呼吸道合胞病毒感染患者（n = 21）的呼吸频率（52次/分钟±7次/分钟 vs 45次/分钟±6次/分钟）和RDI评分（22±4 vs 14±3）有所改善。根据预先设定的标准（用药前呼吸频率降低20%且RDI评分降低50%），硫酸间羟异丙肾上腺素治疗的有效者包括整个样本的45%，12个月及以下者的40%，24个月及以上者的52%，以及呼吸道合胞病毒检测呈阳性患者的48%。尽管似乎存在年龄依赖性的反应程度，但硫酸间羟异丙肾上腺素可有效缓解急性喘息幼儿的呼吸窘迫，包括那些确诊为呼吸道合胞病毒细支气管炎的患儿。
