山莨菪碱治疗小儿多器官功能障碍综合征的临床研究

Treatment of anisodamine in children with multiple organ dysfunction syndrome

目的探讨山莨菪碱治疗小儿多器官功能障碍综合征(MODS)的临床疗效。方法 63例MODS患者随机分为常规治疗组(n=32)和山莨菪碱组(n=31)。观察并比较两组患儿治疗前后的平均动脉压(MAP)、动脉血乳酸(LA)、氧合指数(IO)、小儿危重病评分(PCIS)、器官衰竭评分(Marshall评分)、病死率。结果常规组和山莨菪碱组病死率分别31.3%(10/32)和19.4%(6/31),组间比较差异有显著性(P<0.05);两组治疗5d后的MAP、氧合指数较治疗前均显著提高,差异有显著性(P<0.05),山莨菪碱组治疗后的MAP、氧合指数均明显高于常规组,组间比较差异有显著性(P<0.05);山莨菪碱组治疗6小时后动脉血乳酸即较对照组明显改善,差异有显著性(P<0.001),而对照组治疗6小时后动脉血乳酸较治疗前无显著改善,差异无显著性;两组治疗后的小儿危重病评分(PCIS)均较治疗前明显增高,差异有显著性(P<0.05);山莨菪碱组治疗后的小儿危重病评分(PCIS)均明显高于常规组,组间比较差异有显著性(P<0.05),两组治疗后的Marshall评分均较治疗前明显降低,差异有显著性(P<0.05);山莨菪碱组治疗后的Marshall评分均明显低于常规组,组间比较差异有显著性(P<0.05)。结论在常规治疗的基础上加用山莨菪碱可明显改善小儿MODS患者的循环功能和微循环状况,纠正缺氧状态,阻止小儿MODS危重状态的进展,从而降低死亡率。

【Objective】 To investigate the clinical efficacy of anisodamine in treatment of multiple organ dysfunction syndrome（MODS） in children.【Methods】 63 patients with MODS were randomized into conventional therapy group（n =32） and anisodamine group（n =31）.Mean arterial pressure（MAP）,arterial blood lactate（LA）,oxygenation index（IO）,pediatric critical score（PCIS）,organ failure score（Marshall score）,mortality rate were measured in two groups of patients before and after treatment.【Results】 Mortality rate of conventional group and anisodamine group were 15.6%（5/32） and 9.7%（3/31） respectively and there was no significant difference between 2 groups in mortality rate（P 0.05）;the MAP and IO of both groups after treatment were significantly increased,the differences were statistically significant（P 0.05）;MAP and IO of anisodamine group after treatment were significantly higher than the conventional group,the difference between groups were statistically significant（P 0.05）;the APACHE Ⅱand Marshall score of both groups after treatment were significantly decreased,the differences were statistically significant（P 0.05）;the APACHE Ⅱand Marshall score of anisodamine group after treatment were significantly lower than the conventional group,the difference between groups were statistically significant（P 0.05）.【Conclusion】 On the basis of conventional therapy,application of anisodamine can significantly improve the circulatory function and microcirculation status and correct the hypoxia in children with MODS,but its shortcoming is easy to make the heart rate significantly increased.