哮喘联盟

   摘要
   背景和目的：地塞米松用于儿童急性哮喘发作已被视为与泼尼松/氢化泼尼松等效的治疗手段。尽管已有多个小型试验，但还缺乏明确的共识性数据。该系统综述和荟萃分析旨在确定肌注或口服地塞米松是否与口服5天泼尼松/氢化泼尼松效果等同或更优。研究的主要终点为复诊或再住院情况。
   方法：2013年10月19日，在PubMed（MEDLINE）通过使用关键字地塞米松或地塞米松别名decadron和哮喘或哮喘持续状态检索以确定潜在的研究。6项比较地塞米松与泼尼松/氢化泼尼松用于治疗急诊≤18岁儿童急性哮喘发作的随机、对照试验被列入研究。数据由4位作者提取并由第二作者审核。两位评审者独立地对研究质量进行评价，评定者间的一致性也进行了评估。
   结果：两组在任何时间点复发的相对危险度（RR）无差异（5天RR0.90，95％可信区间[CI]为0.46-1.78，Q =1.86，自由度=3，I2=0.0％，10-14天RR1.14，95％CI为0.77-1.67，Q =0.84，自由度=2，I2=0.0％，或30天RR1.20，95％CI为0.03-56.93）。接受地塞米松的患者无论在急诊科还是在家里都不太可能发生呕吐（RR0.29，95％CI为0.12-0.69，Q =3.78，自由度=3，I2=20.7％）（RR0.32，95％CI为0.14-0.74，Q=2.09，自由度=2，I2=4.2％）。
   结论：医疗人员应该考虑使用单倍或两倍剂量的地塞米松作为替代泼尼松/氢化泼尼松5天疗程的一种可行的药物。
 

（苏楠 审校）
Pediatrics. 2014 Feb 10. [Epub ahead of print]


 

Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis.
 

Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, Gorelick MH, Jackson JL.
 

Abstract

BACKGROUND AND OBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients.Although multiple small trials exist, clear consensus data are lacking. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone.The primary outcome of interest was return visits or hospital readmissions.
METHODS: A search of PubMed (Medline) through October 19, 2013, by using the keywords dexamethasone or decadron and asthma or status asthmaticus identified potential studies. Six randomized controlled trials in the emergency department of children ≤18 years of age comparing dexamethasone with prednisone/prednisolone for the treatment of acute asthma exacerbations were included. Data were abstracted by 4 authors and verified by a second author. Two reviewers evaluated study quality independently and interrater agreement was assessed.
RESULTS: There was no difference in relative risk (RR) of relapse between the 2 groups at any time point (5 days RR 0.90, 95% confidence interval [CI] 0.46-1.78, Q = 1.86, df = 3, I2 = 0.0%, 10-14 days RR 1.14, 95% CI 0.77-1.67, Q = 0.84, df = 2, I2 = 0.0%, or 30 days RR 1.20, 95% CI 0.03-56.93). Patients who received dexamethasone were less likely to experience vomiting in either the emergency department (RR 0.29, 95% CI 0.12-0.69, Q = 3.78, df = 3, I2 = 20.7%) or at home (RR 0.32, 95% CI 0.14-0.74, Q = 2.09, df = 2, I2 = 4.2%).
CONCLUSIONS: Practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone.
 

Pediatrics. 2014 Feb 10. [Epub ahead of print]