Walsh Paul, Caldwell John, McQuillan Kemedy K, Friese Steven, Robbins Dale, Rothenberg Stephen J
Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA, USA.
Acad Emerg Med. 2008 Apr;15(4):305-13. doi: 10.1111/j.1553-2712.2008.00064.x.
To compare the effect of nebulized racemic epinephrine to nebulized racemic albuterol on successful discharge from the emergency department (ED).
Children up to their 18th month of life presenting to two teaching hospital EDs with a clinical diagnosis of bronchiolitis who were ill enough to warrant treatment but did not need immediate intubation were eligible for this double-blind randomized controlled trial (RCT). Patients received either three doses of racemic albuterol or one dose of racemic epinephrine plus two saline nebulizers. Disposition was decided 2 hours after the first nebulizer. Successful discharge was defined as not requiring additional bronchodilators in the ED after study drug administration and not subsequently admitted within 72 hours. Adjusted relative risks (aRR) were estimated using the modified Poisson regression with successful discharge as the dependent variable and study drug and severity of illness as exposures. Secondary analysis was performed for patients aged less than 12 months and first presentation.
The authors analyzed 703 patients; 352 patients were given albuterol and 351 epinephrine. A total of 173 in the albuterol group and 160 in the epinephrine group were successfully discharged (crude RR = 1.08, 95% confidence interval [CI] = 0.92 to 1.26). When adjusted for severity of illness, patients who received albuterol were significantly more likely than patients receiving epinephrine to be successfully discharged (aRR = 1.18, 95% CI = 1.02 to 1.36). This was also true among those with first presentation and in those less than 12 months of age.
In children up to the 18th month of life, ED treatment of bronchiolitis with nebulized racemic albuterol led to more successful discharges than nebulized epinephrine.
比较雾化消旋肾上腺素与雾化消旋沙丁胺醇对急诊科成功出院的效果。
年龄在18个月及以下、因临床诊断为细支气管炎而到两家教学医院急诊科就诊、病情严重到需要治疗但不需要立即插管的儿童，符合这项双盲随机对照试验（RCT）的条件。患者接受三剂消旋沙丁胺醇或一剂消旋肾上腺素加两剂生理盐水雾化剂。在首次雾化后2小时决定处置方式。成功出院定义为在研究药物给药后在急诊科不需要额外的支气管扩张剂，且随后72小时内未入院。使用修正的泊松回归估计调整后的相对风险（aRR），以成功出院为因变量，研究药物和疾病严重程度为暴露因素。对年龄小于12个月的患者和首次就诊患者进行了二次分析。
作者分析了703例患者；352例患者给予沙丁胺醇，351例给予肾上腺素。沙丁胺醇组共有173例成功出院，肾上腺素组有160例成功出院（粗RR = 1.08，95%置信区间[CI] = 0.92至1.26）。在调整疾病严重程度后，接受沙丁胺醇的患者比接受肾上腺素的患者成功出院的可能性显著更高（aRR = 1.18，95%CI = 1.02至1.36）。首次就诊的患者和年龄小于12个月的患者也是如此。
在18个月及以下的儿童中，急诊科用雾化消旋沙丁胺醇治疗细支气管炎比雾化肾上腺素导致更多的成功出院。
