D'Avila Rosângela Silveira, Piva Jefferson P, Marostica Paulo José Cauduro, Amantea Sérgio Luís
Emergency Department of Hospital de Clínicas de Porto Alegre (Brazil), Pediatric Department, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil.
Respir Med. 2008 Jan;102(1):156-61. doi: 10.1016/j.rmed.2007.07.030. Epub 2007 Sep 14.
Evaluate the efficacy of adding two intravenous bolus of aminophylline to the standard treatment of acute asthma episode in children admitted to the pediatric emergency room (PER).
Between March 2001 and February 2002, 60 children (2-5 years old), admitted to the PER at Hospital de Clínicas de Porto Alegre (Brazil), due to an episode of acute asthma, refractory to conventional therapy (an oral dose of steroids and at least three doses of inhaled albuterol, associated or not with oxygen) were enrolled in a randomized, double blind, placebo controlled clinical trial. The randomization was performed in blocks of 10 patients, who received a "bronchodilator solution" (either saline or aminophylline), in two doses: on arrival at the PER and again 6h later. The intervention group received aminophylline 5mg/kg/dose diluted in normal saline (NS) solution up to a 20 mL volume, while the placebo group received plain NS, both in an infusion rate of 1 cc/min. The main outcomes were total length of hospital stay, length of supplemental oxygen use, number of bronchodilator nebulizations and/or aerosol inhalations performed and patient destination. The groups were compared using the Students t-test, Mann-Whitney test and Chi-Square test, accepting p<0.05 as significant.
Comparing the main outcomes, we did not find differences between the placebo and aminophylline groups: 29.0+/-14.7 versus 26.2+/-13.4 beta-agonist nebulizations per patient (p=0.46); 2.4+/-10.6 versus 5.6+/-14.2 aerosol inhalations per patient (p=0.32); 24.7+/-30.0 versus 26.0+/-25.2h for oxygen supplement (p=0.86); 43.2+/-30.0 versus 43.6+/-23.7h for length of hospital stay (p=0.95). We also did not find differences between the two groups related to the blood pressure, heart rate, respiratory rate and oxygen saturation.
In children aged 2-5 years admitted to a PER with asthma, two intravenous doses of 5mg/kg of aminophylline given 6h apart did not change the length of stay in hospital, the number of nebulizations given or the duration of oxygen therapy required. We are unable to tell whether there would be benefit with higher doses of aminophylline designed to give levels in the usual therapeutic range.
评估在儿科急诊室（PER）收治的儿童急性哮喘发作标准治疗方案基础上加用两次静脉推注氨茶碱的疗效。
2001年3月至2002年2月期间，巴西阿雷格里港临床医院PER收治的60名2至5岁因急性哮喘发作且常规治疗（口服一剂类固醇和至少三剂吸入用沙丁胺醇，可联合或不联合吸氧）无效的儿童，被纳入一项随机、双盲、安慰剂对照临床试验。随机分组以10名患者为一组进行，患者接受“支气管扩张剂溶液”（生理盐水或氨茶碱），分两次给药：到达PER时一次，6小时后再一次。干预组接受以生理盐水（NS）溶液稀释至20 mL体积的5mg/kg/剂量氨茶碱，而安慰剂组接受单纯NS，均以1 cc/min的输注速率给药。主要结局指标为住院总时长、补充吸氧时长、进行支气管扩张剂雾化和/或气雾剂吸入的次数以及患者去向。两组比较采用学生t检验、曼-惠特尼检验和卡方检验，以p<0.05为有统计学意义。
比较主要结局指标，我们发现安慰剂组和氨茶碱组之间无差异：每位患者β-受体激动剂雾化次数分别为29.0±14.7次和26.2±13.4次（p=0.46）；每位患者气雾剂吸入次数分别为2.4±10.6次和5.6±14.2次（p=0.32）；吸氧时长分别为24.7±30.0小时和26.0±25.2小时（p=0.86）；住院时长分别为43.2±30.0小时和43.6±23.7小时（p=0.95）。我们还未发现两组在血压、心率、呼吸频率和血氧饱和度方面存在差异。
对于因哮喘入住PER的2至5岁儿童，间隔6小时静脉注射两次5mg/kg氨茶碱并未改变住院时长、雾化次数或所需吸氧治疗的持续时间。我们无法确定给予更高剂量氨茶碱使其达到常规治疗范围内的血药浓度是否会有获益。
