院前急救中应用小剂量肾上腺素抢救重症支气管哮喘的疗效分析

Therapeutic Effects Analysis of Low-dose Epinephrine Rescue for Severe Bronchial Asthma in Pre-hospital First Aid

目的探讨院前急救中小剂量肾上腺素治疗重症支气管哮喘急性发作的临床效果。方法将重症支气管哮喘患者随机分成3组:肾上腺素组(13例)用0.3mg肾上腺素皮下注射,必要时每5min再次皮下注射0.3mg肾上腺素;常规组(23例)立即用甲泼尼龙40～80mg静脉注射,随后将氨茶碱0.25g加入250ml液体中静脉滴注维持,必要时行机械通气;综合组(10例)在常规组治疗基础上加用肾上腺素组的治疗方法。对比3组患者治疗前后临床疗效评分。结果用药前3组患者症状评分间差异无统计学意义(P>0.05)。用药后5、20、30、45min3组症状评分间差异均有统计学意义(P<0.05);常规组与其他两组比较症状评分间差异有统计学意义(P<0.05),肾上腺素组和综合组症状评分间差异均无统计学意义(P>0.05)。肾上腺素组和综合组用药后5min与20min、30min与20min症状评分比较,差异均有统计学意义(P<0.05)。常规组用药30min与5min、20min比较,症状评分间差异有统计学意义(P<0.05)。结论肾上腺素是重症支气管哮喘院前急救的有效药物,尽早使用有利于提高抢救成功率。

Objective To investigate the application of the pre - hospital first aid, by using small and medium - dose epinephrine in severe acute bronchial asthma attack. Methods To divide the patients with severe bronchial asthma into three groups, the epinephrine group, the conventional group and the complex group. For the epinephrine group, to inject O. 3mg epi- nephrine, via subcutaneous injection. If necessary, another 0. 3 mg every 5 minutes. For the conventional group, by conven- tional antiasthmatic treatment, to inject, immediately, 40- 80 mg methylprednisolone, intravenously, then adding 0.25g diprophylline into 250 ml injection fluids to maintain, machinery breathing if necessary. For the complex group, to combine the methods of the first two groups. Comparing the clinical efficacy score changes in the 3 groups, before and after the treatments. Results The epinephrine group treat all success, after injection 5min symptom shown some improvement, 20min improvement obvious, the complex group 5min symptom shown some improvement, the conventional group 20rain shown some improvement. The epinephrine group is better than the conventional group, and no difference from the complex group. But the complex group is better than the conventional group. The differences among the 3 groups have statistical significance （ P 〈 0.05 ）. Conclusion Epinephrine is an effective pre - hospital first aid medicine for severe bronchial asthma. If used as early as possible, it will help improve the success rate of rescue.