Duffy N, Walker P, Diamantea F, Calverley P M A, Davies L
Aintree Chest Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
Thorax. 2005 Sep;60(9):713-7. doi: 10.1136/thx.2004.036046. Epub 2005 Jun 6.
Intravenous aminophylline is commonly used in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD), despite limited evidence for its efficacy and known risks of toxicity. We hypothesised that adding intravenous aminophylline to conventional treatment would not produce clinically important changes in the speed of spirometric or symptomatic recovery or shorten hospital stay in patients with exacerbations of COPD.
Eighty patients admitted to hospital with non-acidotic exacerbations of COPD were recruited at admission to a randomised, double blind, placebo controlled study comparing intravenous aminophylline 0.5 mg/kg/hour after an appropriate loading dose with an equivalent volume of 0.9% saline. The primary outcome was the change in post-bronchodilator forced expiratory volume in 1 second (FEV(1)) over the first 5 days of the admission. Secondary end points were changes in self-reported breathlessness, arterial blood gas tensions, forced vital capacity (FVC), and length of hospital stay.
There was no difference in the post-bronchodilator FEV(1) over the first 5 days between the aminophylline and placebo groups. In the aminophylline group, 2 hours of treatment produced a small but significant rise in arterial pH (p = 0.001) and a fall in arterial carbon dioxide tension (p = 0.01) compared with placebo treatment. There were no differences in the severity of breathlessness, post-bronchodilator FVC, or length of hospital stay between the groups. Nausea was a more frequent side effect in the aminophylline group (46% v 22%; p<0.05), but palpitations and headache were noted equally in both groups.
Although intravenous aminophylline produced small improvements in acid-base balance, these did not influence the subsequent clinical course. No evidence was found for any clinically important additional effect of aminophylline treatment when used with high dose nebulised bronchodilators and oral corticosteroids. Given its known toxicity, we cannot therefore recommend the use of intravenous aminophylline in the treatment of non-acidotic COPD exacerbations.
尽管静脉注射氨茶碱治疗慢性阻塞性肺疾病（COPD）急性加重期的疗效证据有限且存在已知的毒性风险，但它仍常用于该疾病的治疗。我们推测，在常规治疗基础上加用静脉注射氨茶碱不会在肺量计测量的恢复速度或症状恢复方面产生具有临床意义的变化，也不会缩短COPD急性加重期患者的住院时间。
80例因COPD非酸中毒急性加重期入院的患者在入院时被纳入一项随机、双盲、安慰剂对照研究，该研究比较了在给予适当负荷剂量后以0.5mg/kg/小时的速度静脉注射氨茶碱与等量0.9%生理盐水的效果。主要结局是入院后前5天支气管扩张剂后1秒用力呼气量（FEV₁）的变化。次要终点包括自我报告的呼吸困难、动脉血气张力、用力肺活量（FVC）的变化以及住院时间。
氨茶碱组和安慰剂组在入院后前5天支气管扩张剂后FEV₁无差异。与安慰剂治疗相比，氨茶碱组治疗2小时后动脉pH值有小幅但显著升高（p = 0.001），动脉二氧化碳张力下降（p = 0.01）。两组在呼吸困难严重程度、支气管扩张剂后FVC或住院时间方面无差异。恶心在氨茶碱组是更常见的副作用（46%对22%；p<0.05），但两组心悸和头痛的发生率相当。
尽管静脉注射氨茶碱在酸碱平衡方面有小幅改善，但这些并未影响后续临床病程。未发现氨茶碱与高剂量雾化支气管扩张剂及口服糖皮质激素联用时具有任何具有临床意义的额外效果。鉴于其已知的毒性，因此我们不推荐使用静脉注射氨茶碱治疗非酸中毒COPD急性加重期。
