中国循证儿科杂志
中國循證兒科雜誌
중국순증인과잡지
CHINESE JOURNAL OF EVIDENCE-BASED PEDIATRICS
2014年
6期
423-428
,共6页
汪东海%陈建川%易静%杜志银%代继宏
汪東海%陳建川%易靜%杜誌銀%代繼宏
왕동해%진건천%역정%두지은%대계굉
硫酸镁%雾化%哮喘%儿童%Meta分析%随机对照试验%肺功能
硫痠鎂%霧化%哮喘%兒童%Meta分析%隨機對照試驗%肺功能
류산미%무화%효천%인동%Meta분석%수궤대조시험%폐공능
Magnesium sulfate%Nebulized%Asthma%Chlidren%Meta-analysis%Randomized controlled trial%Pulmonary function
目的：系统评价雾化吸入硫酸镁对儿童哮喘急性发作的疗效和安全性。方法检索 PubMed、Medline、EMBASE、Cochrane图书馆、中国生物医学文献数据库、万方数据库、中国知网及维普中文科技期刊数据库，检索时间均从建库至2014年7月31日，获得雾化吸入硫酸镁治疗儿童哮喘的RCT文献。根据 Cochrane系统评价员手册推荐的方法行文献质量评价。以吸入硫酸镁后10、20 min时点肺功能作为主要结局指标，住院率、哮喘严重程度评分和不良事件作为次要结局指标。效应量以SMD及其95%CI表示，采用RevMan软件进行Meta分析，并根据不同肺功能指标和硫酸镁用药方式（单用或合用）行亚组分析。结果8篇RCT文献（ n=1161）进入Meta分析。①吸入后10、20 min时点总体肺功能指标，硫酸镁组与对照组差异无统计学意义（10 min：SMD=_0.32，95%CI：_0.67~0.04，P=0.08；20 min：SMD=_0.11，95%CI：_0.40~0.17，P=0.43）。②按不同肺功能指标和硫酸镁用药方式亚组分析结果显示，吸入后10、20 min，PEF较基线增加百分比硫酸镁组显著低于沙丁胺醇组（10 min：SMD=_0.75，95%CI：_1.29~_0.22，P =0.005；20 min：SMD=_0.46，95%CI：_0.72~_0.20，P=0.006）；FEV1占预计值百分比硫酸镁+沙丁胺醇组与对照组差异无统计学意义（10 min：SMD=_0.03，95%CI：_0.52~_0.46，P=0.89；20 min：SMD=0.04，95%CI：_0.29~0.37，P=0.81）；PEF占预计值百分比硫酸镁+沙丁胺醇组与对照组差异无统计学意义（10 min：SMD=_0.02，95%CI ：_0.23~0.19，P=0.83；20 min：SMD=0.05，95%CI：_0.31~0.42，P=0.78）。③硫酸镁组和对照组在次要结局指标方面总体上没有表现出较大的差别。结论硫酸镁雾化吸入相较于常规雾化治疗无明显优势，单用硫酸镁雾化吸入效果不如沙丁胺醇，硫酸镁与沙丁胺醇联合雾化吸入相较于单用沙丁胺醇无明显协同作用。
目的：繫統評價霧化吸入硫痠鎂對兒童哮喘急性髮作的療效和安全性。方法檢索 PubMed、Medline、EMBASE、Cochrane圖書館、中國生物醫學文獻數據庫、萬方數據庫、中國知網及維普中文科技期刊數據庫，檢索時間均從建庫至2014年7月31日，穫得霧化吸入硫痠鎂治療兒童哮喘的RCT文獻。根據 Cochrane繫統評價員手冊推薦的方法行文獻質量評價。以吸入硫痠鎂後10、20 min時點肺功能作為主要結跼指標，住院率、哮喘嚴重程度評分和不良事件作為次要結跼指標。效應量以SMD及其95%CI錶示，採用RevMan軟件進行Meta分析，併根據不同肺功能指標和硫痠鎂用藥方式（單用或閤用）行亞組分析。結果8篇RCT文獻（ n=1161）進入Meta分析。①吸入後10、20 min時點總體肺功能指標，硫痠鎂組與對照組差異無統計學意義（10 min：SMD=_0.32，95%CI：_0.67~0.04，P=0.08；20 min：SMD=_0.11，95%CI：_0.40~0.17，P=0.43）。②按不同肺功能指標和硫痠鎂用藥方式亞組分析結果顯示，吸入後10、20 min，PEF較基線增加百分比硫痠鎂組顯著低于沙丁胺醇組（10 min：SMD=_0.75，95%CI：_1.29~_0.22，P =0.005；20 min：SMD=_0.46，95%CI：_0.72~_0.20，P=0.006）；FEV1佔預計值百分比硫痠鎂+沙丁胺醇組與對照組差異無統計學意義（10 min：SMD=_0.03，95%CI：_0.52~_0.46，P=0.89；20 min：SMD=0.04，95%CI：_0.29~0.37，P=0.81）；PEF佔預計值百分比硫痠鎂+沙丁胺醇組與對照組差異無統計學意義（10 min：SMD=_0.02，95%CI ：_0.23~0.19，P=0.83；20 min：SMD=0.05，95%CI：_0.31~0.42，P=0.78）。③硫痠鎂組和對照組在次要結跼指標方麵總體上沒有錶現齣較大的差彆。結論硫痠鎂霧化吸入相較于常規霧化治療無明顯優勢，單用硫痠鎂霧化吸入效果不如沙丁胺醇，硫痠鎂與沙丁胺醇聯閤霧化吸入相較于單用沙丁胺醇無明顯協同作用。
목적：계통평개무화흡입류산미대인동효천급성발작적료효화안전성。방법검색 PubMed、Medline、EMBASE、Cochrane도서관、중국생물의학문헌수거고、만방수거고、중국지망급유보중문과기기간수거고，검색시간균종건고지2014년7월31일，획득무화흡입류산미치료인동효천적RCT문헌。근거 Cochrane계통평개원수책추천적방법행문헌질량평개。이흡입류산미후10、20 min시점폐공능작위주요결국지표，주원솔、효천엄중정도평분화불량사건작위차요결국지표。효응량이SMD급기95%CI표시，채용RevMan연건진행Meta분석，병근거불동폐공능지표화류산미용약방식（단용혹합용）행아조분석。결과8편RCT문헌（ n=1161）진입Meta분석。①흡입후10、20 min시점총체폐공능지표，류산미조여대조조차이무통계학의의（10 min：SMD=_0.32，95%CI：_0.67~0.04，P=0.08；20 min：SMD=_0.11，95%CI：_0.40~0.17，P=0.43）。②안불동폐공능지표화류산미용약방식아조분석결과현시，흡입후10、20 min，PEF교기선증가백분비류산미조현저저우사정알순조（10 min：SMD=_0.75，95%CI：_1.29~_0.22，P =0.005；20 min：SMD=_0.46，95%CI：_0.72~_0.20，P=0.006）；FEV1점예계치백분비류산미+사정알순조여대조조차이무통계학의의（10 min：SMD=_0.03，95%CI：_0.52~_0.46，P=0.89；20 min：SMD=0.04，95%CI：_0.29~0.37，P=0.81）；PEF점예계치백분비류산미+사정알순조여대조조차이무통계학의의（10 min：SMD=_0.02，95%CI ：_0.23~0.19，P=0.83；20 min：SMD=0.05，95%CI：_0.31~0.42，P=0.78）。③류산미조화대조조재차요결국지표방면총체상몰유표현출교대적차별。결론류산미무화흡입상교우상규무화치료무명현우세，단용류산미무화흡입효과불여사정알순，류산미여사정알순연합무화흡입상교우단용사정알순무명현협동작용。
Objective To estimate the effect of nebulized magnesium sulfate on treating children with acute asthma. Methods Electronic literature search was performed up to July 2014 at the Cochrane Library,PubMed,EMBASE,CBM,CNKI,VIP and Wanfang database. The randomized controlled trails( RCTs)of nebulised magnesium sulphate for treating acute asthma in children were obtained,including the use of nebulized MgSO4 combined with bronchodilators and compared with the use of bronchodilators. The pulmonary function and adverse drug reaction were selected as primary and secondary outcomes. Data were pooled using random effects meta-analysis of the standardized mean difference( SMD)in pulmonary function by RevMan software. The subgroup analysis was performed for each pulmonary function parameter and magnesium sulfate nebulized with and without other bronchodilators. Results A total of 8 RCTs involving 1 161 patients were included. ①Nebulized MgSO4 had no significant effect upon respiratory function(10 min:SMD= _0. 32,95%CI:_0. 67 to 0. 04,P=0. 08;20 min:SMD= _0. 11,95%CI:_0. 40 to 0. 17,P=0. 43)in children. ②Subgroup analysis:MgSO4 was significantly inferior to salbutamol upon pulmonary function when compared with salbutamol(10 min:SMD= _0. 75,95%CI:_1. 29 to _0. 22,P=0. 005;20 min:SMD= _0. 46,95%CI _0. 72 to _0. 20,P=0. 006);MgSO4 didnˊt show significant effect upon respiratory function( FEV1 %predicted,PEF %predicted)to saline when used in combination with bronchodilators(FEV1% predicted after 10 min:SMD= _0. 03,95%CI:_0. 52 to _0. 46, P=0. 89;PEF% predicted after 10 min:SMD= _0. 02,95%CI:_0. 23 to 0. 19,P =0. 83;FEV1% predicted after 20 min:SMD=0. 04,95%CI:_0. 29 to 0. 37,P=0. 81;PEF% predicted after 20 min:SMD=0. 05,95%CI:_0. 31 to 0. 42,P=0. 78 ). ③Common adverse drug reaction of MgSO4 ,such as arrhythmia,decrement of myotasis reflex were not reported in included 8 studies. There was no difference in incidence of adverse drug reaction between MgSO4 and control groups. Conclusion The use of nebulized MgSO4 in the treatment of acute asthma appears to be less benefit upon improving pulmonary function in children when compared with salbutamol,and to be without significant effect upon improving pulmonary function compared with salbutamol.
