Roué C, Fournier M, Sleiman C, Mal H, Pariente R
Service de Pneumologie, Hôpital Beaujon, Clichy.
Rev Pneumol Clin. 1996;52(2):129-34.
Severe acute asthma remains associated with significant mortality. Medical treatment of acute severe episodes includes oxygentherapy, inhaled or intravenous beta-2-agonists, and high doses of systemic corticosteroids. The benefit of additional treatment with other agents such as nebulized ipratropium bromide, epinephrine and intravenous aminophylline is still not well defined. Mechanical ventilation, which remains necessary in case of life-threatening acute respiratory failure, addresses specific problems: PaCO2 may be allowed to remain elevated and ventilator settings should be chosen that avoid barotrauma under appropriate sedation. The use of inhalation anesthesics, helium or even extracorporeal life support necessitates further study to determine the optimal therapeutic strategy in those particular situations.
重度急性哮喘仍然与显著的死亡率相关。急性重症发作的药物治疗包括氧疗、吸入或静脉注射β-2激动剂以及高剂量全身用皮质类固醇。使用其他药物如雾化异丙托溴铵、肾上腺素和静脉注射氨茶碱进行额外治疗的益处仍未明确界定。对于危及生命的急性呼吸衰竭，机械通气仍然是必要的，它解决了一些特定问题：可允许动脉血二氧化碳分压（PaCO2）保持升高，并且应选择通气设置，在适当镇静的情况下避免气压伤。吸入麻醉剂、氦气甚至体外生命支持的使用需要进一步研究，以确定在这些特殊情况下的最佳治疗策略。
