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雾化吸入肾上腺素对急性重症喉炎患者气道阻塞指标的影响。

The effect of epinephrine by nebulization on measures of airway obstruction in patients with acute severe croup.

作者信息

Argent A C, Hatherill M, Newth C J L, Klein M

机构信息

Division of Paediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Rondebosch, 7700 Cape Town, South Africa.

出版信息

Intensive Care Med. 2008 Jan;34(1):138-47. doi: 10.1007/s00134-007-0855-0. Epub 2007 Oct 3.

Abstract

OBJECTIVES

To demonstrate that tests of pulmonary function applicable to sick infants and small children with acute severe viral croup would provide clear, objective evidence of responsiveness to therapy with nebulized epinephrine.

STUDY DESIGN

Oesophageal pressure changes and airflows at the mouth were measured in 17 patients with acute severe croup, before and after nebulization with epinephrine.

RESULTS

In 12 of the 17 patients there was a significant improvement in respiratory mechanics following epinephrine nebulization. Six of the 12 patients who responded to adrenaline also received 0.9% saline by nebulization, without improvement. No measures derived from combined flow and volume data showed any statistically significant change following epinephrine nebulization. Measures combining flow and pressure data, specifically inspiratory airway resistance, expiratory airway resistance, work of breathing, rate of work of breathing and volume for effort, showed changes of 26%, 33%, 16%, 16% and 46% respectively. The most statistically significant measures were pressure-rate product, pressure-time integral, oesophageal pressure alone and expiratory resistance. These changes persisted for at least 10 min after inhalation although there was some evidence of decline in pharmacologic effect at that time.

CONCLUSIONS

Nebulized epinephrine results in a short-lived improvement in some but not all patients with croup. This reduction in respiratory effort occurs secondary to a decline in inspiratory and expiratory airway resistance. Oesophageal pressures measured via a feeding tube are satisfactory for quantification of the acute response and may be a useful continuous monitoring device. Flow measurements are unhelpful, and continuous administration of nebulized epinephrine should be investigated.

摘要

目的

证明适用于患有急性重症病毒性喉炎的患病婴儿和幼儿的肺功能测试能够提供明确、客观的证据,表明对雾化肾上腺素治疗有反应。

研究设计

对17例急性重症喉炎患者在雾化肾上腺素前后测量食管压力变化和口腔气流。

结果

17例患者中有12例在雾化肾上腺素后呼吸力学有显著改善。对肾上腺素产生反应的12例患者中有6例也接受了雾化0.9%盐水治疗,但无改善。从流量和容积数据组合得出的任何测量指标在雾化肾上腺素后均未显示出任何统计学上的显著变化。结合流量和压力数据的测量指标,特别是吸气气道阻力、呼气气道阻力、呼吸功、呼吸功率和用力容积,分别显示出26%、33%、16%、16%和46%的变化。统计学上最显著的测量指标是压力-速率乘积、压力-时间积分、单独的食管压力和呼气阻力。这些变化在吸入后至少持续10分钟,尽管当时有一些药理学效应下降的证据。

结论

雾化肾上腺素可使部分但并非所有喉炎患者的症状得到短暂改善。呼吸努力的降低是吸气和呼气气道阻力下降的继发结果。通过喂食管测量的食管压力对于量化急性反应是令人满意的,并且可能是一种有用的连续监测装置。流量测量无帮助,应研究持续给予雾化肾上腺素的情况。

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