果糖二磷酸钠联合大剂量Vc辅助治疗儿童支原体肺炎心肌损害的观察

发布时间：2018-01-15 23:01

本文关键词：果糖二磷酸钠联合大剂量Vc辅助治疗儿童支原体肺炎心肌损害的观察　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的在常规治疗的基础上,使用大剂量维生素C联合果糖二磷酸钠以消除氧自由基、增加冠状动脉血流量、改善心肌代谢、增强心肌收缩力、抑制氧自由基和组织胺释放、增加红细胞内二磷酸甘油酸的含量,从而营养心肌辅助治疗支原体肺炎伴心肌损害,通过比较心肌酶谱、心电图、心肌肌钙蛋白、胸部X片等临床指标,观察在治疗儿童支原体肺炎伴有心肌损害时联合治疗是否优于常规临床营养治疗。方法选取在我院儿内科住院治疗的自2015年6至2016年5月诊断为“肺炎支原体合并心肌损害”的患儿,随机分成2组,观察组50例,对照组50例,共100例。2组资料分布一致,没有显著性差异,2组均给予阿奇霉素抗感染,同时给予果糖二磷酸钠、辅酶Q10营养心肌,观察组又在此基础上加用大剂量维生素C营养心肌,疗程均为14天,观察2组患儿的临床症状缓解状况并检测心肌酶谱、心电图、心肌肌钙蛋白、外周血象白细胞计数、超敏C反应蛋白、胸片治疗前后的变化情况。对比两组临床患儿的治疗效果。实验结果采用SPSS 22软件包进行统计学分析,计数资料以率(%)表示,组间比较采用X2检验,计量资料以(?)±s表示,采用方差分析,两组间比较采用t检验,有效率比较采用Ridit分析,以P0.05为差异有统计学意义。结果观察组患儿治疗后临床表现及大部分辅助检查均较对照组有明显改善(P0.05),观察组治愈例数明显较对照组多(P0.05);两组心肌酶谱比治疗前明显下降,且观察组下降程度明显大于对照组(P0.05);心电图恢复时间观察组较对照组缩短(P0.05),肌钙蛋白I阴转率观察组高于对照组(P0.05);治疗后白细胞计数差值在两组间比较差异无统计学意义(P0.05),治疗后超敏C反应蛋白下降明显,观察组下降程度明显大于对照组,差异有统计学意义(P0.05),胸部X片观察,两组患儿治疗后比治疗前均明显好转,但两组间比较治愈率、总有效率差异无统计学意义(P0.05)。观察组患者的临床治愈率(72%),优于对照组(42%),差异有统计学意义(P0.05)。结论果糖二磷酸钠联合大剂量维生素C辅助治疗儿童支原体肺炎心肌损害临床效果显著,优于常规的营养心肌治疗,比单用果糖二磷酸钠治疗效果明显。大剂量维生素C配合果糖二磷酸钠能够起协同作用,对支原体肺炎心肌损害具有良好的改善功能。该试验进一步证明果糖二磷酸钠注射液联合大剂量维生素C静脉用药可用以辅助治疗支原体肺炎心肌损害,临床效果显著,而且患者经济负担小,更适合在基层医院推广使用。
[Abstract]:Objective to eliminate oxygen free radicals, increase coronary blood flow, improve myocardial metabolism and enhance myocardial contractility by using high dose vitamin C combined with fructose diphosphate on the basis of routine therapy. Inhibit the release of oxygen free radicals and histamine, increase the content of glyceric acid diphosphate in erythrocytes, thereby nutritional myocardial treatment of mycoplasma pneumonia with myocardial damage, by comparing myocardial enzyme spectrum, electrocardiogram, cardiac troponin. Chest X ray and other clinical indexes. To observe whether the combined therapy in the treatment of mycoplasma pneumonia with myocardial damage in children is superior to the routine clinical nutritional therapy. Mycoplasma pneumoniae with myocardial damage "in children. They were randomly divided into two groups: the observation group (n = 50) and the control group (n = 50). The distribution of the data in group 2 was consistent, and azithromycin and sodium fructose diphosphate were given to both groups without significant difference. CoQ10 nutritious myocardium, observation group on this basis and high dose of vitamin C nutrition myocardium, the course of treatment is 14 days, observe the two groups of children's clinical symptoms relief and detection of myocardial enzyme spectrum, electrocardiogram. Cardiac troponin, peripheral blood leukocyte count, hypersensitive C-reactive protein. The changes of chest radiographs before and after treatment were compared between the two groups. The results of the experiment were analyzed statistically by SPSS 22 software package, and the counting data were expressed as rate. X2 test was used to measure the data. Analysis of variance (ANOVA), t test and Ridit analysis were used to compare the efficiency of the two groups. Results after treatment, the clinical manifestations and most auxiliary examinations in the observation group were significantly improved than those in the control group (P0.05). The number of cases cured in the observation group was significantly higher than that in the control group (P 0.05). The myocardial enzyme spectrum of the two groups was significantly lower than that of the control group before treatment, and the degree of the decrease in the observation group was significantly higher than that in the control group (P 0.05). The recovery time of ECG in the observation group was shorter than that in the control group (P 0.05), and the positive rate of troponin I in the observation group was higher than that in the control group. After treatment, there was no significant difference in white blood cell count difference between the two groups. After treatment, the hypersensitive C-reactive protein decreased significantly, and the degree of decrease in the observation group was significantly higher than that in the control group. The difference was statistically significant (P 0.05), chest X ray observation showed that the two groups were better than before, but the cure rate was higher between the two groups. There was no significant difference in the total effective rate (P 0.05). The clinical cure rate of the observation group was 72%, which was better than that of the control group (42%). Conclusion the clinical effect of fructose diphosphate combined with high dose vitamin C in the treatment of mycoplasma pneumonia in children with myocardial damage is significant and superior to the routine nutritional myocardial therapy. Compared with fructose diphosphate alone, high dose of vitamin C and sodium fructose diphosphate can play a synergistic effect. It is further proved that fructose sodium diphosphate injection combined with high dose vitamin C intravenous administration can be used to assist the treatment of mycoplasma pneumonia myocardial damage. The clinical effect is remarkable, and the patient's economic burden is small, which is more suitable for popularizing and using in the basic level hospital.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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