哮喘联盟

   摘要
   目的: 前列腺素E1（PGE1）是产科的临床实践中常用的药物，主要用于引产、它可促宫颈成熟和治疗产后出血。然而，到目前为止，其在哮喘患者的使用情况迄今尚未被研究过。药品说明书中提及：其尚会引起不明因果关系的副作用：呼吸困难和支气管痉挛等。其他药理书籍中阐述，使用PGE1可能引起支气管狭窄收缩。本研究的目的是探讨研究接受前列腺素E1治疗对围产期哮喘孕妇患者的影响。研究设计：对2010年1月到2013年12月期间的每个接受PGE1治疗的患者进行从前瞻性记录，并对这些图表进行回顾性分析。找出围产期哮喘患者，并在给予PGE1治疗后，对哮喘的症状加重的证据进行鉴定并进一步的分析。
   结果: 在2629例接受PGE1治疗的孕妇患者中，总共有234例患者(8.9%)被确认患有哮喘。这部分患者没有出现一例发生哮喘急性发作加重的症状（0/234; 95% CI 0-0.017）。在这234例名围产期哮喘患者中，104（44％）例有活动性哮喘，并正在接受每天药物治疗；，其余130例患者有哮喘病史，曾经按需要使用过吸入药物治疗。总共有98例（42％）患者接受总剂量大于400微克的治疗。研究结束后，对本研究研究效能进行了统计学评估，事后统计评估统计结果显示：如果应用PGE1后会增加哮喘急性发作加重的风险，那么本研究有足够的效能发现这个风险。
   结论:基于本研究数据的95%置信区间，应用前列腺素E1后，哮喘加重急性发作的最大风险小于2%。虽然对于在围产期哮喘患者用药需谨慎，但本研究的数据支持，如果患者符合临床指征需要，可以使用前列腺素E1。


 

（苏欣 审校）
AmJObstetGynecol.2014Dec2.pii:S0002-9378(14)02375-8.doi:10.1016/j.ajog.2014.11.042. [Epub ahead of print]


 

The Use of Prostaglandin E1 in Peripartum Patients with Asthma.
 

Thompson MR1, Towers CV2, Howard BC1, Hennessy MD1, Wolfe L1, Heitzman C1.
 

ABSTRACT
OBJECTIVE: Prostaglandin E1 (PGE1) is commonly used in obstetric practice for labor induction, cervical ripening, and in treating postpartum hemorrhage; however, its use in pregnant asthmatic patients has not been studied to date. The package insert states there is an unknown causal side effect for dyspnea and bronchospasm. Other pharmacological publications have stated that bronchoconstriction may occur with the use of PGE1. The study objective was to examine peripartum pregnant asthmatic patients who received prostaglandin E1. STUDY DESIGN: Every patient that was administered PGE1 from January 2010 through December 2013 was prospectively recorded. The charts were retrospectively reviewed. Peripartum patients with asthma were identified and further analyzed for any evidence of an asthma exacerbation following administration of the drug.
RESULTS: A total of 234 of 2629 patients (8.9%) that received PGE1 were identified as having asthma. None of the patients had any evidence of an asthma exacerbation (0/234; 95% CI 0-0.017). Of the 234 patients, 104 (44%) had active asthma and were receiving daily medication and the remaining 130 patients had a medical history of asthma for which they used an inhaler on a prn basis. A total of 98 patients (42%) received greater than 400 micrograms total dose. A post-hoc statistical assessment was performed and the study was sufficiently powered to detect any clinically meaningful increase in asthma exacerbation with PGE1 usage, if such a risk existed.
CONCLUSION: Based on the 95% CI of these data, the maximum risk for an asthma exacerbation following the use of prostaglandin E1 is < 2%. While all medications administered to asthmatic patients in the peripartum period should be carefully selected, this information supports the use of prostaglandin E1 in obstetric patients with asthma, if clinically indicated.
 

AmJObstetGynecol.2014Dec2.pii:S0002-9378(14)02375-8.doi:10.1016/j.ajog.2014.11.042. [Epub ahead of print]