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首页> 外文期刊>The Internet Journal of Asthma, Allergy and Immunology >Intravenous Magnesium Sulfate As An Adjunct In The Treatment Of Severe Asthmatic Patients Non-Responding To Conventional Therapy
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Intravenous Magnesium Sulfate As An Adjunct In The Treatment Of Severe Asthmatic Patients Non-Responding To Conventional Therapy

机译：静脉硫酸镁辅助治疗对常规疗法无反应的重度哮喘患者

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Treatment of acute asthma is based on rapid reversal of bronchospasm and arresting airway inflammation. This study was done to determine the effect of IV MgSO4 for improvement of pulmonary function in patients with acute asthma non - responding to routine therapy presenting to the pulmonary department.These randomized, double- blind, controlled study was conducted on patients (magnesium sulfate group, n=48, aged 12-85 years, 26 men, 22 women and control(saline) group, n=33, aged 15-80 years, 17 men, 16 women) who non-responding to routine treatment. Peak expiratory flow rate (PEFR) was done before MgSO4 (25 mg/kg) and normal saline (100 ml) as a baseline criteria and after infusion of drugs at 30 min and 3 hr. All patients were also given bronchodilators. The main outcome was PEFR. Data were analyzed by x2 and t-test and differences between each point, was considered significant at p< 0.05.The Peak expiratory flow rate 3 hrs after baseline increased in MgSO4 group in comparison with saline group (82.60 5.8 versus 47.8 8.7 p=0.002). The number of breathing in MgSO4 was also increased at 30 min and 3 hr after baseline. Cyanosis, diaphoresis and using of respiratory accessory muscles by patients were decreased in MgSO4 in comparison with saline group. According to the results, it is suggested that MgSO4 can be as an adjunct agent for the treatment of patients with acute non- responding asthma. Introduction Despite advancing knowledge of the pathophysiology and treatment of asthma, its morbidity and mortality are on the rise (1,2). To help avert this trend, clinicians and patients must focus their attention on the early identification and treatment of asthma exacerbation. Management of severe acute asthma attacks sometimes brings difficulty to the physician (3). The goal of management of patients with respiratory failure is to restore then to a state of quiet breathing, without complication. This goal is often achieved by pharmacology alone (4). Brnochodilator management of acute severe asthma has evolved considerably in recent years. Beta–2 agonists have emerged as the single most potent class of bronchodilator available, and the inhalational route of administration has proven to be the most effective and least toxic method of delivery except among apneic or highly uncooperative patients (5). Some current treatment strategies have focused on intravenous (IV) magnesium sulfate (MgSO4) administration in some disease (3). Magnesium sulfate as IV form has been suggested as a treatment for certain emergence conditions for more than 60 years and it is currently proposed to be beneficial in treating asthma, preeclampsia, eclampsia, myocardial infarction and cardiac arrhythmia (6). Intravenous magnesium sulfate has successfully been used in the treatment of acute asthma. There is some evidence that IV form of MgSO4 can provide additional bronchodilation when gives in conjunction with standard bronchodilating agent and corticosteroids (7). One of the important problem for clinicians is managing of drug-resistant disease and non-responding patients. This study was conducted to determine whether IV MgSO4, when used as part of a standardized treatment protocol can improved pulmonary function in non- responding patients to therapy with beta-2 agonists and corticosteroids, presenting to the our pulmonary department with exacerbation of asthma. Materials and Methods This was a randomized, double –blind, controlled clinical trial. Asthmatics aged 12-85 years in acute exacerbation with a peak expiratory flow rate (PEFR) less than 200 (l/min) having taken bronchodilators, corticosteroids and requiring assisted ventilation were included. All patients, who had not responded to treatment during next 6 hr, were selected for this investigation. They were randomized to receive treatment with MgSO4 (25 mg/kg, as MgSO4 group) and saline (100 ml normal saline, as placebo group). Drugs were given as infusion over the 30-45 minutes. For all patients peak exp
机译：急性哮喘的治疗是基于快速逆转支气管痉挛和阻止气道炎症。这项研究旨在确定静脉注射MgSO4对改善对肺科常规治疗无反应的急性哮喘患者肺功能的影响。这些随机，双盲，对照研究是针对患者（硫酸镁组）进行的。 ，对常规治疗无反应的对照组（n = 48，年龄12-85岁，男26例，女性22例），对照组（n = 33，年龄15-80岁，男17例，女性16）。在以MgSO4（25 mg / kg）和生理盐水（100 ml）作为基线标准之前以及在输注药物30分钟和3小时后，达到最大呼气流速（PEFR）。所有患者均接受了支气管扩张药。主要结果是PEFR。通过x2和t检验分析数据，各点之间的差异在p <0.05时被认为是显着的。与盐水组相比，MgSO4组基线后3小时的呼气峰值流速增加（82.60 5.8对47.8 8.7 p = 0.002） ）。基线后30分钟和3小时，MgSO4中的呼吸次数也增加了。与盐水组相比，MgSO4减少了患者的发osis，发汗和呼吸辅助肌的使用。根据结果​​，建议MgSO4可以作为治疗急性无反应性哮喘患者的辅助药物。引言尽管对哮喘的病理生理学和治疗方法的了解有所提高，但其发病率和死亡率仍在上升（1,2）。为了避免这种趋势，临床医生和患者必须将注意力集中在早期识别和治疗哮喘急性发作上。严重的急性哮喘发作的治疗有时给医师带来困难（3）。处理呼吸衰竭患者的目标是使呼吸恢复到安静的呼吸状态，而不会引起并发症。通常仅通过药理学就可以达到这个目标（4）。近年来，急性重症哮喘的支气管扩张剂管理已发生了相当大的发展。 Beta-2激动剂已成为目前可用的最有效的支气管扩张剂，除呼吸暂停或高度不合作的患者外，吸入给药途径已被证明是最有效，毒性最小的给药方法（5）。当前的一些治疗策略集中于在某些疾病中静脉内（IV）硫酸镁（MgSO4）给药（3）。硫酸镁以静脉注射形式已被建议用于某些新兴疾病的治疗已有60多年的历史，并且目前被认为对治疗哮喘，先兆子痫，子痫，心肌梗塞和心律不齐具有有益作用（6）。静脉注射硫酸镁已成功用于治疗急性哮喘。有证据表明，与标准的支气管扩张剂和皮质类固醇联合使用时，Ⅳ型的MgSO4可以提供额外的支气管扩张作用（7）。对于临床医生来说，重要的问题之一是对耐药性疾病和无反应的患者的管理。进行这项研究的目的是确定静脉注射硫酸镁作为标准治疗方案的一部分是否可以改善无反应的患者使用β-2激动剂和皮质类固醇的治疗后的肺功能，从而使我们的肺部疾病加重哮喘发作。材料和方法这是一项随机，双盲，对照临床试验。急性加重期的年龄在12-85岁之间的哮喘患者服用了支气管扩张药，皮质类固醇并需要辅助通气，呼气峰值流速（PEFR）小于200（l / min）。选择在接下来的6小时内对治疗无反应的所有患者进行这项研究。将他们随机接受MgSO4（25 mg / kg，作为MgSO4组）和生理盐水（100 ml生理盐水，作为安慰剂组）的治疗。在30-45分钟内以输液方式给药。对于所有患者，峰值经验值

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