Bohn D, Kalloghlian A, Jenkins J, Edmonds J, Barker G
Crit Care Med. 1984 Oct;12(10):892-6. doi: 10.1097/00003246-198410000-00012.
The management of status asthmaticus using a continuous iv infusion of salbutamol was studied in 14 children with a total of 16 episodes of respiratory failure, unresponsive to conventional bronchodilator therapy. The mean PaCO2 at the start of the infusion was 60 +/- 6 torr. A loading dose of 1 microgram/kg X min body weight was given over 10 min, followed by an infusion of 0.2 microgram/kg X min which was increased in 0.1-microgram/kg steps according to response. The maximum dose was 4 microgram/kg X min. On 11 (69%) occasions a sustained reduction in PaCO2 was achieved within 4 h of starting the infusion. In 5 (11%) instances no reduction in PaCO2 was seen and mechanical ventilation was instituted because of increasing respiratory distress and CO2 retention. Mean heart rate during the infusion increased from 161 to 183 beat/min. Comparison with previous data from 30 pediatric patients (40 infusions) receiving iv isoproterenol showed less effect on heart rate and a more sustained fall in PaCO2 without the recurrence of bronchospasm. We found salbutamol to be a safe and effective bronchodilator capable of reversing severe bronchospasm in most children who would otherwise require mechanical ventilation. Its greater specificity for beta 2-receptors may make it preferable to isoproterenol.
对14名儿童共16次呼吸衰竭发作进行了研究，这些患儿对传统支气管扩张剂治疗无反应，采用持续静脉输注沙丁胺醇治疗哮喘持续状态。输注开始时的平均动脉血二氧化碳分压（PaCO2）为60±6托。在10分钟内给予1微克/千克·分钟体重的负荷剂量，随后以0.2微克/千克·分钟的速度输注，并根据反应以0.1微克/千克的步长增加剂量。最大剂量为4微克/千克·分钟。在11次（69%）情况下，输注开始后4小时内PaCO2持续下降。在5次（11%）情况下，未观察到PaCO2下降，由于呼吸窘迫加重和二氧化碳潴留而进行了机械通气。输注期间的平均心率从161次/分钟增加到183次/分钟。与之前30名接受静脉注射异丙肾上腺素的儿科患者（40次输注）的数据相比，沙丁胺醇对心率的影响较小，PaCO2下降更持久，且无支气管痉挛复发。我们发现沙丁胺醇是一种安全有效的支气管扩张剂，能够逆转大多数否则需要机械通气的儿童的严重支气管痉挛。它对β2受体的特异性更高，可能比异丙肾上腺素更可取。
