Tal A, Bavilski C, Yohai D, Bearman J E, Gorodischer R, Moses S W
Pediatrics. 1983 Jan;71(1):13-8.
Thirty-two infants, aged 1 to 12 months, hospitalized with acute wheezing, were studied. They were randomly divided into four treatment groups of eight patients each. The treatments were intramuscular dexamethasone or placebo (double-blind), and salbutamol (oral and inhaled), or none (open), in all four possible combinations. The study was carried out as a randomized block design with eight blocks of four infants each, matched by age and clinical score. Average daily improvements, as reflected by changes in the clinical score and length of hospital stay, was essentially the same for infants treated with placebo, salbutamol alone, and dexamethasone alone. However, combined salbutamol-dexamethasone treatment resulted in more than twice the rate of improvement of the other treatments. The difference was statistically highly significant (P less than .01). Furthermore, the response of this combined treatment was observed within 24 hours; none of the ten infants in whom there was no significant improvement within 48 hours and neither of the two patients who developed respiratory failure received the combined salbutamol-dexamethasone treatment. A potentiating effect of corticosteroids on the beta-adrenergic responsiveness is a possible explanation for the advantage of this combined treatment in the management of acute wheezing in infancy.
对32名年龄在1至12个月、因急性喘息住院的婴儿进行了研究。他们被随机分为四个治疗组，每组8名患者。治疗方法为肌肉注射地塞米松或安慰剂（双盲），以及沙丁胺醇（口服和吸入），或不进行治疗（开放组），共有四种可能的组合。该研究采用随机区组设计，分为8个区组，每个区组4名婴儿，按年龄和临床评分进行匹配。安慰剂组、单独使用沙丁胺醇组和单独使用地塞米松组的婴儿，在临床评分变化和住院时间方面所反映的平均每日改善情况基本相同。然而，沙丁胺醇与地塞米松联合治疗的改善率是其他治疗方法的两倍多。差异具有高度统计学意义（P小于0.01）。此外，这种联合治疗在24小时内就观察到了效果；在48小时内没有明显改善的10名婴儿中，以及发生呼吸衰竭的2名患者中，没有人接受沙丁胺醇与地塞米松联合治疗。皮质类固醇对β-肾上腺素能反应性的增强作用，可能是这种联合治疗在婴儿急性喘息管理中具有优势的一个解释。
