氨茶碱对急性颈髓损伤并心动过缓患者近期疗效探讨

Short-term Effects of Aminophylline on Bradycardia in Patients with Cervical Spinal Cord Injury

目的 探讨氨茶碱治疗急性颈髓损伤合并心动过缓患者近期疗效.方法 选取急性颈髓损伤后发生心动过缓（心率〈50次/min）患者60例,采用随机数字法将患者分入各组：A组30例,首次静注阿托品0.5mg,之后阿托品3mg＋加入生理盐水至48mL,速度2mL/h,持续24h静脉泵注;B组30例,首次静注氨茶碱0.125 g,之后氨茶碱0.5 g＋加入生理盐水至48mL,速度2mL/h,持续24h静脉泵注.用药期间每2d监测茶碱血药浓度.分析2组的治疗有效率（治疗有效性判定标准：心率≥60次/min）.观察并记录2组患者的腹胀、呕吐、便秘不良反应的发生情况.结果 2组患者ISS评分、性别、年龄、体重、心率等一般情况差异无统计学意义（P〉0.05）.B组治疗有效率为90.00%,明显高于A组（46.67%）,P〈0.01.茶碱血药浓度为1.55～5.27mg/L.B组不良反应发生率为16.67%,明显低于A组30%（P〈0.05）.结论 氨茶碱对急性颈髓损伤合并心动过缓患者具有很好的疗效,且较阿托品不良反应少.

Objective To investigate the short-term effects aminophylline on bradycardia in adult patients with acute cervical spinal cord injury. Methods Sixty patients （heart rate ≤ 50 bpm） with cervical spinal cord injury were admitted into ICU and randomly divided into two groups. Group A： 30 patients were infused intravenously with 0.Smg atropine firstly, and then atropine 3mg mixed with normal saline to 48ml was given as 24 hours intravenous infusion continuously at a speed of 2 mL/h via a pump. Group B： 30 patients were infused intravenously with 0.125 g aminophylline, and then aminophylline 0.5 g mixed with normal saline to 48ml was given as 24 hours intravenous infusion continuously at a speed of 2 mL/h via a pump. At the same time, blood drug concentrations of aminophylline were detected every 2 days. The definition of good effects was heart rate ≥ 60 bpm after administration of drugs. Adverse reactions such as abdominal distension, vomiting and constipation in the two groups were observed and recorded respectively. Results ISS, sex, age, weight, and heart rate baseline when enrolled had no differences between the two groups （P 〉 0.05） . The effective rate of treatment in group B （90.00%） was higher than that of group A （46.67%） （P 〈 0.01） . But the incidence of adverse reactions in group B was lower than that in group A （P 〈 0.05） Blood drug concentrations of theophylline were 1.55-5.27 mg/L. Conclusion Administration of aminophylline on patients with acute cervical spinal cord injury has good effects for bradycardia, which can improve cure rate effectively, and has fewer adverse reactions than atropine.