哮喘急性发作的成人或儿童使用肾上腺素与选择性β-2激动剂的比较：一项系统回顾和荟萃分析
2021/10/20
摘要
背景：国际哮喘指南不建议急性发作哮喘患者使用肾上腺素，除非与过敏反应或血管水肿有关。然而，在许多院前指南中，对于急性严重或危及生命的哮喘，除了雾化吸入选择性β2-激动剂外，还建议肌注肾上腺素。我们对肾上腺素与选择性β2受体激动剂治疗急性哮喘的疗效进行了系统评价。
方法：我们纳入了随机对照试验（RCT）的同行评审出版物，这些随机对照试验将儿童或成人纳入任何医疗环境，并比较了肾上腺素与选择性β2-激动剂治疗哮喘急性发作的情况。主要结果是治疗失败，包括住院、需要插管或死亡。
结果：共纳入1140项研究中的38项。证据的总体质量很低。17项研究为荟萃分析提供了1299名参与者的数据。存在显著的统计异质性，I2=56%。肾上腺素与选择性β2受体激动剂治疗失败的合并 OR为0.99（0.75至1.32），p=0.95。有强有力的证据表明，招募年龄组与治疗失败几率相关；研究招募的成年人肾上腺素治疗失败的几率较低。无法确定肾上腺素加选择性β2受体激动剂是否能改善预后。
结论：现有的低质量证据表明肾上腺素和选择性β2受体激动剂对哮喘急性发作具有相似的疗效。有必要进行高质量的双盲随机对照试验，以确定在吸入或雾化吸入选择性β2受体激动剂的基础上增加肌注肾上腺素是否能改善预后。
Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis
Christina Baggott, Jo Katherine Hardy, Jenny Sparks, Doñah Sabbagh, Richard Beasley, Mark Weatherall, James Fingleton
Abstract
Background:International asthma guidelines recommend against epinephrine (adrenaline) administration in acute asthma unless associated with anaphylaxis or angio-oedema. However, administration of intramuscular epinephrine in addition to nebulised selective β2-agonist is recommended for acute severe or life-threatening asthma in many prehospital guidelines. We conducted a systematic review to determine the efficacy of epinephrine in comparison to selective β2-agonist in acute asthma.
Methods: We included peer-reviewed publications of randomised controlled trials (RCTs) that enrolled children or adults in any healthcare setting and compared epinephrine by any route to selective β2-agonist by any route for an acute asthma exacerbation. The primary outcome was treatment failure, including hospitalisation, need for intubation or death.
Results: Thirty-eight of 1140 studies were included. Overall quality of evidence was low. Seventeen studies contributed data on 1299 participants to the meta-analysis. There was significant statistical heterogeneity, I2=56%. The pooled Peto's OR for treatment failure with epinephrine versus selective β2-agonist was 0.99 (0.75 to 1.32), p=0.95. There was strong evidence that recruitment age group was associated with different estimates of the odds of treatment failure; with studies recruiting adults-only having lower odds of treatment failure with epinephrine. It was not possible to determine whether epinephrine in addition to selective β2-agonist improved outcomes.
Conclusion: The low-quality evidence available suggests that epinephrine and selective β2-agonists have similar efficacy in acute asthma. There is a need for high-quality double-blind RCTs to determine whether addition of intramuscular epinephrine to inhaled or nebulised selective β2-agonist improves outcome.
背景：国际哮喘指南不建议急性发作哮喘患者使用肾上腺素，除非与过敏反应或血管水肿有关。然而，在许多院前指南中，对于急性严重或危及生命的哮喘，除了雾化吸入选择性β2-激动剂外，还建议肌注肾上腺素。我们对肾上腺素与选择性β2受体激动剂治疗急性哮喘的疗效进行了系统评价。
方法：我们纳入了随机对照试验（RCT）的同行评审出版物，这些随机对照试验将儿童或成人纳入任何医疗环境，并比较了肾上腺素与选择性β2-激动剂治疗哮喘急性发作的情况。主要结果是治疗失败，包括住院、需要插管或死亡。
结果：共纳入1140项研究中的38项。证据的总体质量很低。17项研究为荟萃分析提供了1299名参与者的数据。存在显著的统计异质性，I2=56%。肾上腺素与选择性β2受体激动剂治疗失败的合并 OR为0.99（0.75至1.32），p=0.95。有强有力的证据表明，招募年龄组与治疗失败几率相关；研究招募的成年人肾上腺素治疗失败的几率较低。无法确定肾上腺素加选择性β2受体激动剂是否能改善预后。
结论：现有的低质量证据表明肾上腺素和选择性β2受体激动剂对哮喘急性发作具有相似的疗效。有必要进行高质量的双盲随机对照试验，以确定在吸入或雾化吸入选择性β2受体激动剂的基础上增加肌注肾上腺素是否能改善预后。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Thorax. 2021 Sep 30;thoraxjnl-2021-217124. doi: 10.1136/thoraxjnl-2021-217124.)
(Thorax. 2021 Sep 30;thoraxjnl-2021-217124. doi: 10.1136/thoraxjnl-2021-217124.)
Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis
Christina Baggott, Jo Katherine Hardy, Jenny Sparks, Doñah Sabbagh, Richard Beasley, Mark Weatherall, James Fingleton
Abstract
Background:International asthma guidelines recommend against epinephrine (adrenaline) administration in acute asthma unless associated with anaphylaxis or angio-oedema. However, administration of intramuscular epinephrine in addition to nebulised selective β2-agonist is recommended for acute severe or life-threatening asthma in many prehospital guidelines. We conducted a systematic review to determine the efficacy of epinephrine in comparison to selective β2-agonist in acute asthma.
Methods: We included peer-reviewed publications of randomised controlled trials (RCTs) that enrolled children or adults in any healthcare setting and compared epinephrine by any route to selective β2-agonist by any route for an acute asthma exacerbation. The primary outcome was treatment failure, including hospitalisation, need for intubation or death.
Results: Thirty-eight of 1140 studies were included. Overall quality of evidence was low. Seventeen studies contributed data on 1299 participants to the meta-analysis. There was significant statistical heterogeneity, I2=56%. The pooled Peto's OR for treatment failure with epinephrine versus selective β2-agonist was 0.99 (0.75 to 1.32), p=0.95. There was strong evidence that recruitment age group was associated with different estimates of the odds of treatment failure; with studies recruiting adults-only having lower odds of treatment failure with epinephrine. It was not possible to determine whether epinephrine in addition to selective β2-agonist improved outcomes.
Conclusion: The low-quality evidence available suggests that epinephrine and selective β2-agonists have similar efficacy in acute asthma. There is a need for high-quality double-blind RCTs to determine whether addition of intramuscular epinephrine to inhaled or nebulised selective β2-agonist improves outcome.
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急诊科使用雾化镁vs安慰剂加沙丁胺醇对难治性急性哮喘患儿住院情况的影响：一项随机临床试验
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Tezepelumab治疗成年和青少年重度难治性哮喘
