哮喘联盟

   摘要
   背景：静脉注射硫酸镁，与支气管扩张剂和全身性类固醇联合用于中度和重度哮喘的抢救治疗不经常使用。我们假设，雾化镁会带来获益且没有不应有的风险。
   设计和方法：年龄在2～14岁中度和重度哮喘（PRAM严重程度评分≥4）住进疗养/观察室护理的患者，入院时均接受沙丁胺醇-异丙托溴铵联合雾化和静脉注射甲基强的松龙的强化治疗后随机双盲接受800毫克的雾化镁或生理盐水安慰剂。达到出院标准的时间是主要结果;被选择检测的样本容量有15％的绝对改善。PRAM严重程度评分随时间的改善和其他次要结果在总体的组和严重哮喘子集间进行了比较。
   结果：191例硫酸镁组和174例安慰剂组患者符合分析标准。各组的平均基线相似，PRAM分数>7。与安慰剂相比，盲法主动治疗显著增加了后治疗后2小时的血镁水平，0.85vs0.82mmol / L，P= 0.001。无重大不良反应。加速的失效时间分析表明硫酸镁组不显著地缩短了14％达到出院所需的时间，OR =1.14，95％CI0.93至1.40，P =0.20。试验组和安慰剂组达到出院标准所需的平均时间分别为是14.7小时[SD9.7] 与15.6小时[SD11.3]的，P =0.41。
   结论：将雾化镁加入雾化支气管扩张剂和全身类固醇激素的联合疗法中未能显著缩短中度或重度儿童哮喘患者的出院时间。儿科肺病学。

 

（苏欣 审校）
Pediatr Pulmonol. 2015 Feb 4. doi: 10.1002/ppul.23158. [Epub ahead of print]


 

Nebulized magnesium for moderate and severe pediatric asthma: A randomized trial.
 

Alansari K1, Ahmed W, Davidson BL, Alamri M, Zakaria I, Alrifaai M.

ABSTRACT
BACKGROUND: Intravenous magnesium sulfate, a rescue therapy added to bronchodilator and systemic steroid therapy for moderate and severe asthma, is uncommonly administered. We hypothesized that nebulized magnesium would confer benefit without undue risk.
DESIGN AND METHODS: Patients aged 2 to 14 y with moderate and severe asthma (PRAM severity score ≥4) admitted to infirmary/observation unit care were randomized double-blind on admission to receive 800 mg nebulized magnesium or normal saline placebo after all received intensive therapy with combined nebulized albuterol-ipratropium and intravenous methylprednisolone. Time to medical readiness for discharge was the primary outcome; sample size was chosen to detect a 15% absolute improvement. Improvement over time in PRAM severity score and other secondary outcomes were compared for the overall group and severe asthma subset.
RESULTS: One hundred and ninety-one magnesium sulfates and 174 placebo patients met criteria for analysis. The groups were similar with mean baseline PRAM scores >7. Blinded active therapy significantly increased blood magnesium level 2 hr post-treatment completion compared to placebo, 0.85 vs 0.82 mmol/L, P = 0.001. There were no important adverse effects. Accelerated failure time analysis showed a non-significantly shortened time to medical readiness for discharge of 14% favoring the magnesium sulfate group, OR = 1.14, 95% CI 0.93 to 1.40, P = 0.20. Mean times until readiness for discharge were 14.7 hr [SD 9.7] versuss 15.6 hr [SD 11.3] for the investigational and placebo groups, respectively, P = 0.41.
CONCLUSIONS: Adding nebulized magnesium to combined nebulized bronchodilator and systemic steroid therapy failed to significantly shorten time to discharge of pediatric patients with moderate or severe asthma. Pediatr Pulmonol.

Pediatr Pulmonol. 2015 Feb 4. doi: 10.1002/ppul.23158. [Epub ahead of print]