哮喘儿童应用对乙酰氨基酚安全性的系统评价

A Systematic Review of Acetaminophen Administration in Children with Asthma

目的:评价哮喘儿童应用对乙酰氨基酚的安全性。方法:检索Medline、EMBASE、Cochrane Library、中国知网、万方数据库和维普中文科技期刊数据库中有关哮喘儿童应用对乙酰氨基酚的文献。对文献进行质量评价,系统评价哮喘儿童应用对乙酰氨基酚的安全性。数据分析采用Revman 5.3.3软件进行。结果:3篇RCT文献共纳入434例患儿。与对照组(布洛芬或者安慰剂)相比,对乙酰氨基酚组患儿在哮喘急性发作风险(OR=1.11,95%CI:0.71,1.75,P=0.64)、哮喘急性发作次数(MD=-0.06,95%CI:-0.33,0.21,P=0.67)、哮喘控制时间百分比(MD=-1.00,95%CI:-3.94,1.94,P=0.51)、沙丁胺醇急救吸入次数(MD=-0.20,95%CI:-0.97,0.57,P=0.61)、非计划就医频次(MD=-0.01,95%CI:-0.26,0.24,P=0.94)、呼出气一氧化氮(MD=4.00,95%CI:-11.40,19.40,P=0.61)、肺功能指标[第一秒用力呼气容积(FEV_(1))、1秒率(FEV_(1)/FVC)、最大呼气中期流速(MMEF)]差异均无统计学意义(P>0.05)。结论:应用对乙酰氨基酚不增加轻度持续哮喘幼儿及学龄前儿童哮喘急性发作,不影响哮喘的控制水平。单剂量对乙酰氨基酚不会导致短期肺功能改变。

Objective:To evaluate the safety of Acetaminophen administration in children with asthma.Method:Literature on the use of acetaminophen in children with asthma was searched from Medline,EMBASE,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP Chinese Science and Technology Journal Database.The quality of the literature was evaluated,and the safety of acetaminophen in children with asthma was systematically analyzed.Meta analysis was performed with Revman 5.3.3 software.Result:Three trials including 434 cases were investigated.Meta-analysis showed that relative rate of asthma exacerbations(OR=1.11,95%CI:0.71,1.75,P=0.64),the number of asthma exacerbations(MD=-0.06,95%CI:-0.33,0.21,P=0.67),the percentage of asthma-control days(MD=-1.00,95%CI:-3.94,1.94,P=0.51),use of an albuterol rescue inhaler(MD=-0.20,95%CI:-0.97,0.57,P=0.61),unscheduled health care utilization for asthma(MD=-0.01,95%CI:-0.26,0.24,P=0.94),fractional exhaled nitric oxide levels(MD=4.00,95%CI:-11.40,19.40,P=0.61).Lung function indices[including forced expiratory volume in 1 second(FEV_(1)),forced expiratory volume in 1 second(FEV_(1))/forced vital capacity(FVC)and the forced expiratory flow between 25%and 75%of expired vital capacity(MMEF)]showed any significant change after acetaminophen or placebo administration in children with asthma(P>0.05).Conclusion:Administration of Acetaminophen does not increase the incidence of asthma exacerbation in preschool children with mild persistent asthma,does not affect the control of asthma.A single dose of Acetaminophen does not cause lung function to change during short time.