Scarfone R J, Fuchs S M, Nager A L, Shane S A
Department of Pediatrics (Division of Ambulatory Care), University of Pittsburgh School of Medicine, PA.
Pediatrics. 1993 Oct;92(4):513-8.
Recent studies have shown that the use of parenteral corticosteroids in the emergency department decreases the hospitalization rate for patients with acute asthma. We studied the efficacy of oral corticosteroids in the emergency department treatment of moderately ill children with acute asthma.
Emergency department patients aged 1 through 17 years whose chief complaint was acute asthma were assigned a pulmonary index, based on clinical evaluation. Those with a moderate exacerbation (pulmonary index = 9 through 13) received either 2 mg/kg of oral prednisone or placebo in a randomized, double-blind fashion. Patients in each group were then treated with an identical regimen of frequent aerosolized albuterol, for up to a maximum of 4 hours.
Seventy-five patients were assessed. Overall, 11 (31%) of 36 in the prednisone group required hospitalization compared with 19 (49%) of 39 in the placebo group (P = .10). Among the sickest patients (initial pulmonary index > 10), 7 (32%) of 22 prednisone-treated patients required hospitalization compared with 13 (72%) of 18 placebo-treated patients (P < .05). Among patients who had a suboptimal response to initial beta 2-agonist therapy and who therefore would have been hospitalized had treatment been restricted to 2 hours, 9 (45%) of 20 in the prednisone group ultimately required hospitalization when duration of care was extended 2 additional hours compared with 15 (83%) of 18 in the placebo group (P < .05). In addition, prednisone-treated patients had a significantly greater improvement in median pulmonary index (5.0 vs 3.0, P < .001).
These data demonstrate that oral prednisone, within 4 hours of its administration, reduced the need for hospitalization among a subset of children treated in the emergency department for acute asthma.
近期研究表明，在急诊科使用肠胃外皮质类固醇可降低急性哮喘患者的住院率。我们研究了口服皮质类固醇在急诊科治疗中度急性哮喘患儿中的疗效。
以临床评估为基础，为年龄在1至17岁、主诉为急性哮喘的急诊科患者分配一个肺部指数。中度加重（肺部指数=9至13）的患者以随机、双盲方式接受2mg/kg口服泼尼松或安慰剂治疗。然后，每组患者均接受相同方案的频繁雾化沙丁胺醇治疗，最长可达4小时。
共评估了75例患者。总体而言，泼尼松组36例中有11例（31%）需要住院，而安慰剂组39例中有19例（49%）需要住院（P=0.10）。在病情最严重的患者（初始肺部指数>10）中，22例接受泼尼松治疗的患者中有7例（32%）需要住院，而18例接受安慰剂治疗的患者中有13例（72%）需要住院（P<0.05）。在对初始β2激动剂治疗反应欠佳、因此若治疗仅限于2小时就会住院的患者中，泼尼松组20例中有9例（45%）在护理时间延长2小时后最终需要住院，而安慰剂组18例中有15例（83%）需要住院（P<0.05）。此外，接受泼尼松治疗的患者肺部指数中位数改善显著更大（5.0对3.0，P<0.001）。
这些数据表明，口服泼尼松在给药后4小时内，可减少急诊科治疗的一部分急性哮喘患儿的住院需求。
