Takamasu T, Yanagawa S, Kurihara K
Department of Allergy, Kanagawa Children's Medical Center.
Arerugi. 1998 May;47(5):504-10.
We investigated the efficacy and the side effects of "high-dose isoproterenol continuous nebulization" for childhood status asthmaticus. Subjects were 34 children who were hospitalized and underwent the nebulization therapy. The 50 ml solution of 0.5% dl-isoproterenol was diluted in 500 ml of normal saline and nebulized through an ultrasound nebulizer. The period of continuous nebulization was 25.5 +/- 16.0 hours. The Wood's clinical score clearly decreased in 32 cases, the average score changing from 7.7 +/- 0.8 to 2.9 +/- 1.3. Heart rate was elevated significantly during the first 3 hours (156 +/- 25/min at the start of the nebulization, 180 +/- 20/min at 1 hour, 171 +/- 23 at 3 hours), and then it decreased gradually to 122 +/- 25/min at the cessation of the nebulization. Serum GOT, LDH, CPK, and potassium were elevated after the nebulization compared with the values before the treatment, though the changes were not statistically significant. CPK-MB fraction after the nebulization was higher than normal range in 12 of 13 subjects. Of 34 subjects, 11 (32%) complained nausea or vomited, 2 showed arrhythmia on ECG (ventricular premature conduction), 1 developed myocardiac infarction, and 1 developed possible heart failure, some of which might be attributable to the pharmacological side effects of isoproterenol nebulization. We conclude that "high-dose isoproterenol continuous nebulization" is an effective method for childhood status asthmaticus, but there is some risk of serious side effects. This method was originally developed as a method indicated for the case of respiratory failure or threatened respiratory failure following status asthmaticus, and we should not extend the indication of this method thoughness.
我们研究了“大剂量异丙肾上腺素持续雾化吸入”治疗儿童哮喘持续状态的疗效及副作用。研究对象为34名住院并接受雾化治疗的儿童。将50ml 0.5%消旋异丙肾上腺素溶液稀释于500ml生理盐水中，通过超声雾化器进行雾化。持续雾化时间为25.5±16.0小时。32例患儿Wood临床评分明显下降，平均分由7.7±0.8降至2.9±1.3。雾化开始后头3小时心率显著升高（雾化开始时为156±25次/分钟，1小时时为180±20次/分钟，3小时时为171±23次/分钟），然后在雾化结束时逐渐降至122±25次/分钟。雾化后血清谷草转氨酶（GOT）、乳酸脱氢酶（LDH）、肌酸磷酸激酶（CPK）和钾离子水平较治疗前升高，尽管变化无统计学意义。13名受试者中有12名雾化后的CPK-MB同工酶高于正常范围。34名受试者中，11名（32%）主诉恶心或呕吐，2名心电图显示心律失常（室性早搏），1名发生心肌梗死，1名可能发生心力衰竭，其中一些可能归因于异丙肾上腺素雾化吸入的药理副作用。我们得出结论，“大剂量异丙肾上腺素持续雾化吸入”是治疗儿童哮喘持续状态的有效方法，但存在一些严重副作用的风险。该方法最初是作为哮喘持续状态后呼吸衰竭或有呼吸衰竭风险病例的一种治疗方法开发的，我们不应随意扩大该方法的适应证。
