不同剂量酚妥拉明对新生儿肺炎伴肺动脉高压的心功能指标的影响

The influence of different dosage of phentolamine on heart functional parameter of pneumonia in newborns accompanied by pulmonary artery hypertension

目的:探讨不同剂量酚妥拉明对新生儿肺炎伴肺动脉高压心功能指标的影响。方法:连续监测22例重型肺炎患儿生命体征的变化,分别于应用酚妥拉明前及不同用药剂量时,经彩色多普勒超声测定左心室射血分数(EF),左心室短轴缩短率(FS),二尖瓣口血流频谱E峰、A峰值流速(EV、AV)以及肺动脉压力(PAP)的变化。结果:当酚妥拉明以5μg/(kg.min)速度静滴时,PAP及EF显著下降(P<0.05),加大剂量至10μg/(kg.min)时,PAP进一步下降,但体循环压力也开始出现明显的下降,且心率加快。MVA/E比值随酚妥拉明剂量增加呈下降的趋势,但差异无统计学意义(P>0.05)。随酚妥拉明剂量增加,患儿开始出现明显的鼻塞症状。结论:酚妥拉明扩张小动脉,减轻心脏的前后负荷,同时扩张支气管,改善呼吸,静脉应用对重型肺炎伴肺动脉高压患儿有良好的血流动力学效应,宜从小剂量开始,最适剂量为5μg/(kg.min)。

Objective： To investigate the influence of different dosage of phentolamine on heart functional parameter of pneumonia in newborns accompanied by pulmonary artery hypertension. Methods： Vital signs were measured in 22 newborns with severe pneumonia before and after taking different dosages of the application of phento- lamine. Through color Doppler, the left ventricular ejection fraction（EF）,shortening fraction（FS） ,maximal mitral velocity in early and late diastole（EV,AV）and the changes of pulmonary arterial pressure（PAP） were determined. Results： PAP and EF significantly decreased when patients were given phentolamine in a dose of 5 μg/（kg·min） （ P 〈 0. 05） ;PAP declined further when in a dose of 10 μg/（kg·min）, while the systemic circulation pressure and heart rate commenced to change. The ratio of MVA/E were decreased with dosage＇s augment,but not significant. And snuffles presented conspicuously . Conclusion ： Phentolamine intravenous infused takes favourable haemodynamics effect ,dilate pulmonary blood vessel relative selectivity and simultaneously relieve before and afterload. The authors suggest the optimum dose be 5μg/（kg·min）.