Díaz J E, Dubin R, Gaeta T J, Pelczar P, Bradley K
Department of Emergency Medicine, New York Medical College, Lincoln Medical and Mental Health Center, Bronx, USA.
Acad Emerg Med. 1997 Feb;4(2):107-13. doi: 10.1111/j.1553-2712.1997.tb03715.x.
To determine the efficacy of combination therapy using atropine sulfate and albuterol in the treatment for an acute exacerbation of asthma.
A prospective, randomized double-blind, placebo-controlled study was performed in the ED of a large, inner-city, university-affiliated teaching hospital. Participants were a convenience sample of patients presenting to the ED between September 1993 and March 1994 with acute exacerbations of their asthma. Patients judged to be in extremis were excluded. All patients received 3 nebulized treatments with 2.5 mg of albuterol at 0, 30, and 60 minutes. Patients were randomized into 1 of 3 groups with the following added to their nebulizer solutions: 1) saline placebo during all 3 treatments; 2) 2.0 mg atropine sulfate added to the first nebulizer and saline in the second and third; or 3) 2.0 mg atropine to the first and third treatments (with saline in the second). No other medication was administered during the study period. At 90 minutes, the patients were evaluated for admission or release from the ED according to predetermined criteria, and additional medications were given as necessary. Vital signs, peak expiratory flow rate (PEFR), degree of wheezing, level of distress, and side effects were measured before and after each nebulizer treatment.
Of the 153 patients eligible for the study, 126 completed the entire study protocol. There was no significant difference between the 3 groups on any parameter studied, including improvement of PEFR, vital signs, or level of distress. There was no difference in the admission rate between the 3 groups, nor was there a difference in the incidence of side effects among the groups.
In this study population, combination therapy with atropine sulfate and albuterol offered no significant benefit over the use of albuterol alone in the treatment for acute exacerbation of asthma.
确定硫酸阿托品与沙丁胺醇联合治疗哮喘急性加重期的疗效。
在一所大型市中心大学附属医院的急诊科进行了一项前瞻性、随机双盲、安慰剂对照研究。研究对象为1993年9月至1994年3月间因哮喘急性加重到急诊科就诊的患者的便利样本。病情危急的患者被排除。所有患者在0、30和60分钟时接受3次2.5毫克沙丁胺醇雾化治疗。患者被随机分为3组中的1组，在雾化溶液中添加以下物质：1）所有3次治疗均使用生理盐水安慰剂；2）第一次雾化添加2.0毫克硫酸阿托品，第二次和第三次添加生理盐水；或3）第一次和第三次治疗添加2.0毫克阿托品（第二次添加生理盐水）。研究期间未给予其他药物。90分钟时，根据预定标准评估患者是否需要住院或从急诊科出院，必要时给予额外药物。在每次雾化治疗前后测量生命体征、呼气峰值流速（PEFR）、哮鸣程度、痛苦程度和副作用。
153名符合研究条件的患者中，126名完成了整个研究方案。3组在任何研究参数上均无显著差异，包括PEFR改善、生命体征或痛苦程度。3组的住院率无差异，各组间副作用发生率也无差异。
在本研究人群中，硫酸阿托品与沙丁胺醇联合治疗在哮喘急性加重期的治疗中，相比单独使用沙丁胺醇并无显著益处。
