硫酸镁治疗成人哮喘急性发作的系统评价（英文）

A systematic review of magnesium sulfate for acute asthma in adults

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。

In order to provide evidence for making clinical decision, the role of intravenous and nebulized MgSO4 in treatment of adult＇s acute asthma was systematically estimated in the present study. Pubmed, Embase, Web of Sciences, the Cochrane Library and two Chinese literature databases （CNKI, WanFang） were systematically searched up to January 2016. Randomized controlled trails （RCTs） that compared the clinical outcomes of MgSO4 groups and placebo groups were included. The primary outcome was hospital admission. Secondary outcomes included pulmonary function, symptom scores, vital signs and adverse events. The methodological quality of the included studies was evaluated, and the forest plots with meta-analysis were drawn by RevMan 5.2. A total of 24 RCTs derived from 2931 patients were included. Both intravenous MgSO4 and nebulized MgSO4 treatments had no effect upon hospital admission （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）. Both intravenous MgSO4 and nebulized MgSO4 treatments were associated with significant evidence upon respiratory function （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）, but sensitivity analyses showed that outcomes were changed by omitting studies of less than 100 individuals （SMD 0.05, 95% C1-0.05 to 0.15, P = 0.35; SMD 0.05, 95% C1-0.16 to 0.25, P = 0.64）. There were no statistically significant differences in clinical symptom scores and vital signs （heart or pulse rate; systolic blood pressure; respiratory rate） in either form of MgSO4 compared with placebo groups （P〉0.05）. There were no serious adverse events reported in any literature. Overall, there was no role for intravenous and nebulized MgSO4 in the management of acute asthma in adults. Considering the low risk of serious adverse effects and easy availability, it seemed reasonable to use intravenous or nebulized MgSO4 treatment in adults with life threatening asthma in whom any potential benefit would justify the risks of treatment.