Lugo R A, Salyer J W, Dean J M
Department of Pharmacy Practice, University of Utah College of Pharmacy, Salt Lake City 84112, USA.
Pharmacotherapy. 1998 Jan-Feb;18(1):198-202.
To determine whether clinicians continue to treat acute bronchiolitis with nebulized albuterol despite lack of clinical improvement after such treatment, we reviewed the medical records of 90 randomly selected infants and children with the primary diagnosis of that disorder who were treated in this 232-bed tertiary care children's hospital. Clinical improvement and no clinical improvement were defined as improvement and lack of improvement, respectively, in air movement, wheezing, retractions, oxygen saturation, work of breathing, and respiratory rate after administration of nebulized albuterol. Response to nebulized albuterol was determined from explicit written documentation in the medical records. Of 68 children who received nebulized albuterol in the emergency department, 52% had written documentation indicating no clinical improvement; however, 94% had admission orders to continue the therapy. Within 12 hours after admission, 61% were again noted to have no clinical improvement with nebulized albuterol. Eighty-seven percent of nonresponders continued to receive albuterol throughout hospitalization, and 54% continued to receive it after discharge. Continuing therapy despite lack of response resulted in unnecessary medical expenses.
为了确定临床医生是否会在雾化吸入沙丁胺醇治疗后缺乏临床改善的情况下仍继续使用该药物治疗急性细支气管炎，我们回顾了在这家拥有232张床位的三级儿童专科医院接受治疗的90例随机选取的、初步诊断为此疾病的婴幼儿和儿童的病历。临床改善和无临床改善分别定义为雾化吸入沙丁胺醇后，气流、喘息、三凹征、血氧饱和度、呼吸功和呼吸频率的改善和未改善。雾化吸入沙丁胺醇的反应是根据病历中的明确书面记录确定的。在急诊科接受雾化吸入沙丁胺醇治疗的68例儿童中，52%的病历书面记录显示无临床改善；然而，94%的患儿有继续治疗的入院医嘱。入院后12小时内，61%的患儿再次被记录为雾化吸入沙丁胺醇后无临床改善。87%无反应的患儿在住院期间持续接受沙丁胺醇治疗，54%在出院后仍继续接受治疗。尽管无反应仍继续治疗导致了不必要的医疗费用。
