腎上腺素注射與β2-agonist噴霧劑在治療小兒急性氣喘之比較

A Comparative Study of Epinephrine Injection and β2-Agonist Inhalation in the Treatment of Childhood Asthma

丁正凱(Cheng-Kai Ting) ； 廖明厚(Ming-Hou Liao)

《Acta Paediatrica Sinica》 32卷6期 (1991/12) Pp. 372-381

摘要

本文針對29位小兒急性氣喘發作之學童進行研究比較傳統皮下注射腎上腺素與霧氣吸入terbutaline兩種療法之優劣並進行交叉治療比較其再反應之機率，文中顯示兩組經治療後都有明顯的進步，其肺功能PEFR值之上昇均呈統計上有意義，其P值分別為0.0001、0.0001。就組內不同時段間之差異分別以Wilcoxon-signed rank test測試10分鐘、20分鐘、30分鐘與初始值間之P值顯示法組則分別為0.0007、0.0003、0.0003。若把條件設的再嚴謹些只取PEFR初值於正常預測值40%時，則治療後10分鐘與初值之比較顯示在epinephrine組P值僅為0.059，而霧氣吸入組則有P＝0.0038，在20分鐘後雖兩組P值皆小於0.05。但霧氣治療組之平均值仍比腎上腺素注射組來的高，顯示霧氣吸入療法至少作用出現的也較早，但在兩大組別同一時段間經Mann Whitney U test比較顯示均無法達到P值小於0.05，即使在初值都小於正常40%的兩組亦然，在交叉治療的12位患者中，兩組各佔6位，其中初值低又初步治療效果不理想的各佔5位，經交叉治療後其平均值兩組都能呈有意義之上昇，顯示初步治療後若效果不佳時交叉治療不失為另一重要治療方法之考慮，就以反應率來看，兩組似乎都有50％左右。在評估其它因子中發現對治療反應關聯最大的是發作時之肺功能PEFR值初始值，愈低者治療後其平均PEFR值愈小，相對治療後增加提昇PEFR值之量亦愈少，其它如年齡，發作至急診就醫的時間等則呈統計上無意義。就使用劑量上來講，terbutaline 2.5-5mg在學童氣喘病患身上並不易看到如epinephrine那樣引起的蒼白、頭痛、手顫、心跳過速等副作用，故原則上建議霧氣吸入beta-agonist療法應為急診處理小兒急性氣喘的第一手療法，但當治療效果不盡理想時亦應記得再用傳統療法有時仍有佳績之機會。

並列摘要

A total of 29 cases were enrolled in this study and divided randomly into Group I (traditional epinephrine injection) and Group II (terbutaline nebulizer inhalation), If patients did not respond well to the initial therapy. a crossover therapeutic regimen was assigned and their pulmonary function, peak expiratory flow rate (PEFR) was measured every 10 minutes for half an hour. Both groups of patients revealed significant improvement post initial treatment P＜0.0001). Within group difference was analysis by Wilcoxon signed rank test. All subgroups at 10 minutes, 20 minutes, and 30 minutes were compared in terms of their baseline pulmonary function, epinephrine group P value showed 0.0059, 0.0038, 0,0025; and terbutaline nebulizer inhalation group P value showed as 0,0007, 0.0003, 0.0003 respectively. An analysis of the group with an initial PEFR below 40% of the normal predicted or the more severely ill childhood acute asthmatic patients, the ten minutes post-treatment PEFR value of the epinephrine group showed P=0.059; a significant P value of 0.0038 was noted for the terbutaline inhalation group, but both group p value was ＜0.05 at 20.30 minutes post-treatment, respectively. Between-group difference was analysed by Mann Whitney U test. Although all time interval mean data showed higher for the terbutaline inhalation group, statistically it showed P＞0.05. The above data suggest terbutaline inhalation therapy at the dosage noted will have early onset of action and better early clinical improvement than the traditional epinephrine iniection regimen. There seemed to be no difference in degree of improvement between the two regimens. Observation of crossover treatment found a 50% re-response rate in both group of of patients who did not respond well to their initial regimen, and post crossover treatment PEFR all showed statistically significant improvement. However, still there was no significant difference between the two groups. This suggests that the terbutaline nebulizer inhalation method can not totally replace the more traditional method of acute asthma management, and emphasizes that a crossover therapeutic regimen should be kept in mind because the reresponse rate is still encouraging. According to the variance analysis, the most important factor influencing the final outcome was the degree of severity of the initial asthmatic attack. The lower in initial PEFR value. The worse the clinical response. Other factors like age, sex, duration of asthma (year) and time interval between onset to arrival at the emergency room, showed as neither significant nor important. Although the terbutaline dosage used in this study was not low, clinically almost all children tolerated it well, and the pallor, tremor, headache, irritability and tachycardia were less than for the epinephrine group.

並列關鍵字

PEFR (peak expiratory flow rate) ； terbutaline ； epinephrine ； bronchial asthma ； beta-agonist