Skorodin M S, Tenholder M F, Yetter B, Owen K A, Waller R F, Khandelwahl S, Maki K, Rohail T, D'Alfonso N
Medical Service, Veterans Affairs Hospital, Hines, Ill.
Arch Intern Med. 1995 Mar 13;155(5):496-500.
Acute exacerbations of chronic obstructive pulmonary disease are commonly seen and difficult to treat. We sought to determine the bronchodilator efficacy of magnesium sulfate in this situation, as this compound is helpful in acute asthma.
Subjects who came to either of two Veterans Affairs emergency departments were randomized in a double-blind fashion to receive either 1.2 g of magnesium sulfate or placebo over 20 minutes after they first received albuterol, 2.5 mg by nebulization. Peak expiratory flow, dyspnea scores, arterial hemoglobin oxygen saturation by pulse oximetry, maximal inspiratory and expiratory pressures, and vital signs were monitored for 45 minutes after the start of magnesium sulfate or placebo treatment.
Seventy-two individuals were studied. The peak expiratory flow increased 16.6% +/- 27.7% (mean +/- SD) in both groups after the initial albuterol treatment, from 121.2 +/- 55.7 L/min to 136.9 +/- 63.9 L/min. The peak expiratory flow increased from 136.7 +/- 69.7 L/min at the start of the infusion to 162.3 +/- 76.6 L/min at 30 minutes and 161.3 +/- 78.7 L/min at 45 minutes with magnesium sulfate treatment. The peak expiratory flow was 137.0 +/- 58.6 L/min on initiation of the intravenous infusion, 143.0 +/- 72.7 L/min at 30 minutes, and 143.3 +/- 70.5 L/min at 45 minutes in the placebo group. The difference in peak expiratory flow from initiation of the infusion to 30 and 45 minutes later (calculated as means of the 30- and 45-minute values) was significantly different for the two groups (25.1 +/- 35.7 L/min vs 7.4 +/- 33.3 L/min; P = 0.3); the difference was also significant when expressed as percentage increase (22.4% +/- 28.5% vs 6.1% +/- 24.4%; P = .01). There was a statistically nonsignificantly trend toward a reduced need for hospitalization in the magnesium sulfate group as compared with the placebo group (28.1% vs 41.9%; P = .25). There were no significant changes in the other parameters with either treatment.
Magnesium sulfate, 1.2 g over 20 minutes after beta-agonist administration, is safe and modestly efficacious in the treatment of acute exacerbations of chronic obstructive pulmonary disease, and its bronchodilator effect is greater than that of a beta-agonist given alone and lasts beyond the period of magnesium sulfate administration.
慢性阻塞性肺疾病急性加重很常见且难以治疗。我们试图确定硫酸镁在此种情况下的支气管扩张剂疗效，因为该化合物对急性哮喘有帮助。
前往两家退伍军人事务部急诊科之一的受试者在首次接受雾化吸入2.5mg沙丁胺醇后，以双盲方式随机分组，在20分钟内接受1.2g硫酸镁或安慰剂治疗。在硫酸镁或安慰剂治疗开始后45分钟监测呼气峰值流速、呼吸困难评分、经脉搏血氧饱和度测定的动脉血红蛋白氧饱和度、最大吸气和呼气压力以及生命体征。
共研究了72名个体。初始沙丁胺醇治疗后，两组的呼气峰值流速均增加了16.6%±27.7%（平均值±标准差），从121.2±55.7L/分钟增至136.9±63.9L/分钟。硫酸镁治疗时，呼气峰值流速从输注开始时的136.±69.7L/分钟在30分钟时增至162.3±76.6L/分钟，在45分钟时增至161.3±78.7L/分钟。安慰剂组静脉输注开始时呼气峰值流速为137.0±58.6L/分钟，30分钟时为143.0±72.7L/分钟，45分钟时为143.3±70.5L/分钟。两组从输注开始至30分钟和45分钟后呼气峰值流速的差异（计算为30分钟和45分钟值的平均值）有显著差异（25.1±35.7L/分钟对7.4±33.3L/分钟；P = 0.3）；以百分比增加表示时差异也显著（22.4%±28.5%对6.1%±24.4%；P = 0.01）。与安慰剂组相比，硫酸镁组住院需求减少的趋势无统计学意义（28.1%对41.9%；P = 0.25）。两种治疗方法对其他参数均无显著影响。
在给予β受体激动剂后20分钟内输注1.2g硫酸镁治疗慢性阻塞性肺疾病急性加重是安全且有一定疗效的，其支气管扩张作用大于单独使用β受体激动剂，且在硫酸镁输注期后仍持续存在。
