Efficacy of beta(2)-agonists in bronchiolitis: A reappraisal and meta-analysis
Efficacy of beta(2)-agonists in bronchiolitis: A reappraisal and meta-analysis
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DOI：
10.1542/peds.100.2.233
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发表时间：
1997-08-01
期刊：
影响因子：
8
通讯作者：
Horwitz, RI
中科院分区：
文献类型：
--
作者：
Flores, G;Horwitz, RI
客观的。评估 β(2) 激动剂治疗细支气管炎的疗效。设计。吸入β(2)-激动剂随机对照试验的严格审查和荟萃分析。结果。确定了三项住院研究和五项门诊研究。住院患者研究（82 名患者）的特点是治疗方案和结果测量存在很大差异。在患者的选择和指定中发现了一些问题，例如未能评估研究前的疾病持续时间或排除已经服用支气管扩张剂的患者。由于研究结果、结果评估时间和药物治疗方案存在很大差异，因此无法对住院试验进行荟萃分析。住院试验的结果是矛盾的：一项发现治疗后临床评分显着降低，住院时间缩短，而另外两项仅发现显着的氧饱和度降低。门诊研究（251 名患者）检查了两次治疗后生理指标和临床评分的立即变化，但没有检查临床医生惯用的长期治疗方案的效果。荟萃分析显示，短期β(2)激动剂治疗对住院率或呼吸频率没有影响，对氧饱和度和心率有统计学显着但临床上不显着的影响。评分系统的多样性阻碍了临床评分数据的汇集。结论。尽管有八项临床试验，β(2) 激动剂治疗细支气管炎的疗效仍缺乏确凿的证据。需要精心设计的住院试验。门诊研究的荟萃分析不支持使用β(2)激动剂治疗细支气管炎，但研究人员尚未研究结果和临床医生惯用的长期门诊治疗方案。
Objective. To evaluate the efficacy of beta(2)-agonists in bronchiolitis.Design. Critical review and meta-analysis of randomized controlled trials of inhaled beta(2)-agonists.Results. Three inpatient and five outpatient studies were identified. Inpatient studies (82 patients) were characterized by wide variability in therapeutic regimens and measurement of outcomes. Several problems were identified in the selection and specification of patients, such as failure to assess the prestudy duration of illness or to exclude patients already taking bronchodilators. Metaanalysis was not possible for inpatient trials due to the great variability in study outcomes, timing of outcome assessment, and drug regimens. Results of inpatient trials were contradictory: one found significant reductions in the clinical score and a shorter hospital stay with treatment, whereas two others found only significant oxygen desaturations. Outpatient studies (251 patients) examined immediate changes in physiologic measures and clinical scores after two treatments, but have not examined the effects of the longer-term regimen customarily used by clinicians. Meta-analysis revealed that short-term beta(2)-agonist therapy had no impact on the hospitalization rate or respiratory rate, and had a statistically significant but clinically insignificant impact on oxygen saturation and heart rate. The diversity of scoring systems precluded pooling of clinical score data.Conclusions. Despite eight clinical trials, conclusive evidence for the efficacy of beta(2)-agonist therapy for bronchiolitis remains unavailable. Well-designed inpatient trials are needed. Meta-analysis of outpatient studies does not support the use of beta(2)-agonist therapy for bronchiolitis, but investigators have not studied the outcomes and the long-term outpatient regimen customarily used by clinicians.