硝普钠对肠道病毒71型感染手足口病低血压期临床疗效分析

Effect of sodium nitroprusside in treatment of hand,foot and mouth disease due to enterovirus 71 in hypotensive phase

目的探讨硝普钠在肠道病毒71型（EV71）感染合并心肺功能障碍治疗中的作用和价值。方法采用病例一对照分析方法，对10例临床确诊为危重症EV71手足口病（低血压期）患儿进行回顾性分析，探讨低血压期应用硝普钠对血压、脉搏、末梢循环及肺水肿的治疗效果。选择既往予米力农／肾上腺素治疗的8例EV71感染肺水肿／肺出血患儿作为对照。结果10例患儿入院时均出现肺水肿、肺出血、心功能紊乱及低血压症状，均行气管插管、机械通气治疗，2例合并严重室性心律紊乱，2例多次心脏骤停。10例患儿均在出现循环障碍加重、血压下降时行硝普钠试验，并给予硝普钠静脉滴注治疗，硝普钠最大剂量为3．5μg／（kg·min），平均应用硝普钠时间为（29±18）h，于给药30min～1h后患儿出现面色及末梢循环改善，脉搏有力，30min～2h后出现心率逐渐下降，血压回升至正常水平，未见不良反应发生。结论低血压期是EV71感染手足口病患儿的急危重症，手足口病合并休克综合征与交感神经兴奋导致的急性左心室功能紊乱相关，硝普钠能有效的减轻心脏后负荷，纠正休克，改善预后。

Objective To investigate the curative effect of sodium nitroprusside in the treatment of EV71-related pneumoedema/pneumorrhagia and hypotension in this study. Methods This was a retrospective study of a total 10 children with EV71-related pneumoedema/pneumorrhagia treated with sodium nitroprusside using case-control methods. The clinical manifestations and outcomes of the l0 children （present cohort） were compared with those of 8 children （past cohort） who had EV71-related pneumoedema/pneumorrhagia without sodium nitroprusside. Results Among these 10 patients, all were at the appearance of pneumoedema/pneumorrhagia ,cardiac arrhythmia and hypotension. Two patients showed severe cardiac arrhythmia, two patients showed cardiac arrest for many times. All 10 patients were treated with mechanical ventilation and other conventional treatments. At the first time of the manifest of hypotension, sodium nitroprusside were put into practice in all 10 patients. Ten patients were treated with intravenously sodium nitroprusside in the stage of hypotension by maximal dose of 3.5 μg/（kg·min）. The mean times of intravenously sodium nitroprusside was （29 ±18） h. After 30 min - 1 h,the patients showed an improvement in vultus,pulse and peripheral circulation and decrease of heart rate and elevation of blood pressure after 30 rain -2 h,but at least 2-6 h later,the blood pressure tended to stabilize at normal standard. Conclusion Hypotension is the intensive stage in EV71-related hand,foot and mouth disease, and the shock syndrome caused by acute left ventricular disorder is related to sympathetic nerve activity. Sodium nitroprusside can effectively reduce the cardiac afterload, and correct shock and improve the prognosis.