沙丁胺醇与多索茶碱3种时序给药的安全性比较

Comparison of safety of salbutamol and doxofylline treatments with 3 different orders

目的探讨给药时序不同对沙丁胺醇与多索茶碱联用安全性的影响。方法研究对象为2012年9月至2014年12月在北京医院呼吸与危重症医学科病房住院、需要联用沙丁胺醇和多索茶碱治疗的患者。先将护士分为A、B、C 3组，符合入选要求的患者入院时逢哪组护士值班即进入哪组。A组患者沙丁胺醇雾化吸入结束后静脉滴注多索茶碱，B组患者沙丁胺醇雾化吸入与多索茶碱静脉滴注同时进行，C组患者多索茶碱静脉滴注结束后给予沙丁胺醇雾化吸入（7 d为一个疗程，用药1～2个疗程，第1疗程出现不良反应者即停止治疗）。观察3组患者的不良反应发生情况。结果3组各纳入患者100例。A组男性63例，平均年龄（71±13）岁；B组男性58例，平均年龄（71±12）岁；C组男性64例，平均年龄（73±12）岁。疾病诊断主要为慢性阻塞性肺疾病、肺炎、肺癌、肺部感染、支气管扩张、支气管哮喘等。3组之间患者年龄、性别分布和不同疾病所占百分比差异均无统计学意义（均P＞0.05）。3组共有16例患者发生不良反应24例次，其中心悸12例次，呼吸困难加重10例次，手指震颤2例次。A、B、C组不良反应发生率分别为2%（2/100）、10%（10/100）和5%（5/100），A组与B组之间不良反应发生率差异有统计学意义（P=0.045）。结论给药时序对沙丁胺醇与多索茶碱联用安全性有明显影响，采用沙丁胺醇雾化吸入结束后再静脉滴注多索茶碱的给药时序，患者不良反应发生率最低。

Objective To explore the safety of salbutamol and doxofylline treatments with different orders.MethodsThe subjects were inpatients who need to be treated with salbutamol and doxofylline in Department of Respiratory and Critical Care Medicine Ward, Beijing Hospital during September 2012 to December 2014. Firstly, the nurses were divided into A, B, and C groups and the admitted patients in accordance with inclusion criteria were entered into the on-duty nurses′ group. The patients in the group A received intravenous injection of doxofylline after salbutamol inhalation, the patients in the group B received salbutamol inhalation and intravenous injection of doxofylline at the same time, and the patients in the group C received salbutamol inhalation after intravenous injection of doxofylline （a total of 1 to 2 treatment cycles, the treatment was stopped if adverse reactions occurred）. The adverse reactions in the 3 groups were observed.ResultsEach group comprised 100 patients. There were 63 males in the group A and average age was （71±13） years; 58 males in the group B and average age was （71±12） years; 64 males in the group C and average age was （73±12） years. The diseases in patients in the 3 groups included chronic obstructive pulmonary disease, pneumonia, lung cancer, lung infection, bronchiectasis, and bronchial asthma, etc. The differences of age, gender distribution, and percentages of different diseases among the three groups were not statistically significant （all P〉0.05）. Totally 24 cases of adverse reactions appeared in 16 patients in the 3 groups, including 12 cases of palpitations, 10 cases of shortness of breath, and 1 case of finger tremor. The incidence of adverse reactions in the 3 groups were 2% （2/100）, 10% （10/100）, and 5% （5/100）, respectively. The difference between the group A and the group B was statistically significant （P=0.045）.ConclusionsSalbutamol inhalation and intravenous injection of doxofylline with different order had an marked impact on medication safety. The incidence of adverse reactions was the lowest when the patients were given intravenous injection of doxofylline after salbutamol inhalation.