米力农与西地兰治疗婴幼儿重症肺炎合并心力衰竭的临床疗效观察

发布时间：2018-04-28 21:32

  本文选题：婴幼儿 + 重病肺炎合并心力衰竭　； 参考：《河北医科大学》2012年硕士论文

【摘要】：目的：心力衰竭是儿科常见的急症之一,婴幼儿期较儿童期更多见。重症肺炎以及先天性心脏病合并重症肺炎是婴幼儿时期发生急性心力衰竭的常见原因。心力衰竭是指由于心功能的减退,心脏虽经发挥代偿能力,仍不能泵出足够的氧合血,以满足全身组织代谢需要的一种临床综合症。如果不能够及时的诊断以及合理的治疗,心力衰竭会进一步发展成为心源性休克,危及患儿生命。本文通过分析和观察60例重症肺炎合并心力衰竭患儿的呼吸频率、心率、肝脏大小、尿量以及BNP的变化情况,来比较两种治疗方案(西地兰治疗方案与米力农治疗方案)对控制心力衰竭有无差别。 方法：以2010年10月-2011年12月期间我院儿科病房收治的重症肺炎合并心力衰竭患儿60例为研究对象,对患儿的呼吸频率、心率、肝脏大小、尿量以及BNP的变化情况进行监测。其中男36例,女24例；最小年龄2个月,最大年龄8个月。根据治疗方案的不同,将60例患儿随机分成两组,即西地兰治疗组(n=30例),和米力农治疗组(n=30例)。西地兰治疗组的方案：在常规治疗(吸氧、镇静、抗感染)的基础上加用西地兰,具体用法是：=2岁,0.03mg/kg。首先应给予洋地黄化：首次给予总量的1/2,余量分2次,每隔6小时给予一次。洋地黄化后12小时开始给予维持量,维持量为总量的1/4,每天给予一次,直到心力衰竭纠正。米力农组治疗的方案：在常规治疗(吸氧、镇静、抗感染)的基础上加用米力农,具体用法是：首先给予负荷量50ug/kg,5分钟缓慢静注,以后每分钟0.5ug/kg维持.一般每天给予12小时,直到心力衰竭纠正为止。 心力衰竭诊断标准：《第七版儿科学》。并除外先天性心脏病、心律失常、扩张性心肌病等引起的心力衰竭。所有病人入院前均未接受强心药的治疗,入院后20分钟内收集病人的资料,记录下患儿的呼吸频率、心率、肝脏大小以及尿量,同时采取患儿的BNP。以后每3小时观察一次病人,记录患儿的呼吸频率、心率、肝脏大小以及尿量情况,直到患儿心力衰竭控制(标准为：患儿的呼吸频率≤59次/分、心率≤159次/分、肝脏3cm、尿量200ml)。如果患儿入院时的BNP100pg／ml,可在第二天、第四天复查BNP。同时留取20例健康儿童血的BNP作为对照组。 所有记录的数据用SPSS13.0统计软件进行统计学处理,先进行正态分布的检验,结果是p0.1,为偏态分布,结果用中位数表示。组间采用多个独立样本非参数检验,P0.05表示差异有统计学意义。 结果： 1米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿呼吸频率的影响 米力农治疗组与西地兰治疗组重症肺炎合并心力衰竭患儿呼吸频率得到改善的时间用中位数表示均为2天两组比较,结果P0.05,无统计学意义：米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿的呼吸频率改善作用无明显差别。 2米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿心率的影响 米力农治疗组与西地兰治疗组重症肺炎合并心力衰竭患儿心率得到改善的时间用中位数表示均为2天,两组比较,结果P0.05,无统计学意义：米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿的心率改善作用无明显差别。 3米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿肝脏回缩的影响 米力农治疗组与西地兰治疗组重症肺炎合并心力衰竭患儿肝脏回缩得到改善的时间用中位数表示均为2天。两组比较,结果P0.05,无统计学意义：米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿的肝脏回缩改善作用无明显差别。 4米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿尿量的影响 米力农治疗组与西地兰治疗组重症肺炎合并心力衰竭患儿尿量恢复到正常的时间用中位数表示均为1天。两组比较,结果P0.05,无统计学意义：米力农治疗组与西地兰治疗组对重症肺炎合并心力衰竭患儿的尿量改善作用无明显差别。 5临床上诊断的婴幼儿重症肺炎合并心力衰竭患儿的BNP与健康婴幼儿BNP的关系 米力农治疗组婴幼儿重症肺炎合并心力衰竭患儿的BNP用中位数表示为6.050pg/ml,西地兰治疗组婴幼儿重症肺炎合并心力衰竭患儿的BNP用中位数表示为6.200pg/ml,正常婴幼儿的BNP用中位数表示为6.550pg/ml,两组比较,结果P0.05,无统计学意义：临床上诊断婴幼儿重症肺炎合并心力衰竭患儿的BNP不高于健康婴幼儿的BNP。 结论： 1米力农治疗组对婴幼儿重症肺炎合并心力衰竭患儿的呼吸频率、心率、肝脏回缩、尿量的改善作用与西地兰治疗组对婴幼儿重症肺炎合并心力衰竭患儿的改善作用无明显差别。 2临床上诊断婴幼儿重症肺炎合并心力衰竭的患儿BNP不高,因此,临床上不能以BNP的高低作为诊断婴幼儿重症肺炎合并心力衰竭的金标准。
[Abstract]:Objective: heart failure is one of the most common emergencies in pediatrics. Childhood is more common than childhood. Severe pneumonia and congenital heart disease combined with severe pneumonia are the common causes of acute heart failure in infants. Heart failure means that the heart can not pump enough oxygen because of the impairment of heart function. A clinical syndrome that meets the needs of the body metabolism. If it is not timely diagnosis and reasonable treatment, heart failure will further develop into cardiogenic shock and endanger the life of children. In this article, the respiratory rate, heart rate, liver size and urine volume of 60 cases of severe pneumonia combined with heart failure were analyzed and observed. And the changes of BNP, to compare the difference between the two treatment regimens (the treatment of the drug and Milrinone Treatment) on the control of heart failure.
Methods: 60 children with severe pneumonia and heart failure treated in the pediatric ward of our hospital from October 2010 -2011 to December were studied. The respiratory frequency, heart rate, liver size, urine volume and the changes of BNP were monitored. Among them, 36 males and 24 females, the minimum age of 2 months, and the maximum age of 8 months. 60 children were randomly divided into two groups, namely, the treatment group (n=30), and the Milrinone Treatment Group (n=30). The scheme of the treatment group was added to the routine treatment (oxygen inhalation, sedative, anti infection). The specific usage was =2 years old, and 0.03mg/kg. should be first given to the total amount of 1/2 and remainder for the first time. 2 times, every 6 hours were given once every 6 hours. After 12 hours of yellowing, the amount of maintenance was given, the amount of 1/4 was given, one time every day, until the heart failure was corrected. Milinon was treated with milrinone on the basis of conventional treatment (oxygen inhalation, sedative, anti infection). The specific usage was to give the load of 50ug/kg, 5 points first. The clock is slowly injected, then 0.5ug/kg per minute. Give 12 hours a day until the heart failure is corrected.
The criteria for diagnosis of heart failure: < seventh edition of Pediatrics >. Except for congenital heart disease, arrhythmia, dilated cardiomyopathy, all patients were not treated with cardiac drugs before admission, and the patient's data were collected within 20 minutes after admission to record the frequency, heart rate, liver size and urine volume of the children. The patient was observed every 3 hours after BNP.. The patient's respiratory frequency, heart rate, liver size, and urine volume were recorded until the child's heart failure control (standard: the child's respiratory frequency was less than 59 / sub, the heart rate was less than 159 / sub, the liver 3cm, the urine volume 200ml). If the child was admitted to the hospital, the BNP100pg / ml could be second days, Fourth BNP. was checked in 20 healthy children and BNP was used as control group.
The data of all the records were statistically processed by SPSS13.0 statistical software, and the results were P0.1. The result was a partial distribution. The results were expressed in the median. Multiple independent samples were used for non parametric tests, and P0.05 indicated that the difference was statistically significant.
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