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系统定量评价静脉注射和雾化吸入硫酸镁治疗成人哮喘急性发作的有效性和安全性,为临床决策提供证据。系统检索Pubmed,Embase,the Web of Sciences,Cochrane图书馆、CNKI及万方数据库,检索时限至2016年1月。全面收集静脉注射和雾化吸入硫酸镁对比安慰剂治疗成人哮喘急性发作的随机对照研究(RCTs),主要结局指标为住院率,次要结局指标包括肺功能、临床症状评分、生命体征、不良反应、对符合纳入标准的文献进行质量评价,并运用RevM an 5.2软件进行meta分析。共纳入24个RCTs,2931例患者。静脉注射和雾化吸入硫酸镁都未显著降低成人急性哮喘患者的住院率(RR 0.91,95%CI 0.80 to 1.03,P=0.14;RR 0.78,95%CI 0.56 to 1.08,P=0.14)。可改善患者的肺功能(SMD 0.23,95%CI0.03 to 0.43,P=0.02;SMD 0.37,95%CI 0.11 to 0.64,P=0.006);但踢除小样本研究作敏感性分析显示静脉注射和和雾化吸入都未能改善患者肺功能(SMD 0.05,95%CI–0.05 to 0.15,P=0.35;SMD 0.05,95%CI–0.16 to 0.25,P=0.64)。静脉注射和雾化吸入硫酸镁与安慰剂比较,患者临床症状评分和生命体征(心率、收缩压、呼吸频率)无明显改变(P>0.05)。无一篇文献报道严重不良反应的发生。因此,静脉注射和雾化吸入硫酸镁对成人哮喘急性发作未显示有利影响。考虑到硫酸镁发生严重不良反应的低风险性和易获得性,可考虑在威胁生命的哮喘急性发作患者中使用静脉注射或雾化吸入硫酸镁治疗。
A systematic quantitative evaluation of the efficacy and safety of intravenous and nebulized magnesium sulfate in the treatment of acute asthma attacks in adults provides evidence for clinical decision making. Pubmed, Embase, the Web of Sciences, Cochrane Library, CNKI and Wanfang databases were searched systematically. The search time is up to January 2016. A comprehensive randomized controlled study (RCTs) of intravenous and nebulized inhaled magnesium sulfate versus placebo for the treatment of acute asthma in adults was performed. The primary outcome measures were hospitalization rates, secondary outcome measures including lung function, clinical symptom scores, vital signs, adverse reactions The quality of the literature that meets the inclusion criteria was evaluated and the meta-analysis was performed using RevM an 5.2 software. A total of 24 RCTs were enrolled, with 2931 patients. Both intravenous and nebulized magnesium sulfate did not significantly reduce hospital admissions for acute asthma in adults (RR 0.91, 95% CI 0.80 to 1.03, P = 0.14; RR 0.78, 95% CI 0.56 to 1.08, P = 0.14). (SMD 0.23, 95% CI 0.03 to 0.43, P = 0.02; SMD 0.37, 95% CI 0.11 to 0.64, P = 0.006); however, a small sample study of the kick-off sensitivity analysis showed that intravenous And nebulization did not improve pulmonary function (SMD 0.05, 95% CI-0.05 to 0.15, P = 0.35; SMD 0.05, 95% CI-0.16 to 0.25, P = 0.64). Compared with placebo, intravenous and nebulized magnesium sulfate showed no significant change in clinical symptom scores and vital signs (heart rate, systolic pressure and respiration rate) (P> 0.05). No one reported the occurrence of serious adverse reactions. Therefore, intravenous and nebulized magnesium sulphate did not show a beneficial effect on the acute episodes of adult asthma. Considering the low risk and accessibility of severe adverse reactions to magnesium sulfate, consider using intravenous or nebulized magnesium sulphate in patients with acute attacks of life-threatening asthma.