不同剂量甲泼尼龙治疗重症手足口病疗效比较

Comparison of curative effects of different doses of methylprednisolone in treatment of severe hand-foot-mouth disease

目的:探讨不同剂量甲泼尼龙对重症手足口病的临床治疗效果。方法:120例重症手足口病(2期,3A期)患儿随机数字法分为治疗组和对照组各60例,均予丙种球蛋白1 g.kg-1.d-1,脱水降颅压、抗病毒、退热、营养支持等综合治疗,在此基础上对照组给予甲泼尼龙2 mg.kg-1.d-1,2次/d,静脉滴注;治疗组予甲泼尼龙10～15 mg.kg-1.d-1,1次/d,静脉滴注,同时予奥美拉唑0.6 mg.kg-1.d-1,1次/d,静脉滴注,3天后甲泼尼龙改2 mg.kg-1.d-1,2次/d。观察两组患儿的临床治疗效果及激素的不良反应。结果:治疗组患儿的热退时间、易惊消失时间、心率及血压恢复正常时间较对照组明显缩短(P<0.01),病情进展至3B期或4期的发生率、上呼吸机的发生率明显低于对照组(P<0.01),发生肺水肿、肺出血的比例明显低于对照组(P<0.05),并发消化道出血、低钾血症、低钙血症、高血糖及继发感染的发生率与对照组相当(P>0.05)。结论:短期大剂量甲泼尼龙治疗重症手足口病疗效显著,不良反应与小剂量甲泼尼龙治疗差异无统计学意义,值得临床推广。

Objective:To explore the clinical curative effects of different doses of methylprednisolone in treatment of severe hand-foot-mouth disease(HFMD).Methods:One hundred and twenty children with severe HFMD(stage 2 and 3A) were divided into treatment group and control group by random number table,60 children in each group,all the children were treated with comprehensive therapy,including immunoglobulin injection(1 g·kg-1·d-1),dehydration,reducing intracranial pressure,anti-viral therapy,defervescence,and nutritional support;on the basis of comprehensive therapy,the children in control group were treated with intravenous drip of methylprednisolone(2 mg·kg-1·d-1),twice a day;the children in treatment group were treated with intravenous drip of methylprednisolone(10-15 mg·kg-1·d-1,once a day) combined with intravenous drip of omeprazole(0.6 mg·kg-1·d-1,once a day),the dose of methylprednisolone changed to 2 mg·kg-1·d-1 three days later,twice a day.The clinical effects and adverse reactions of hormone therapy in the two groups were observed.Results:The defervescence time,disappearance time of easy to be frightened,the times of heart rate and blood pressure return to normal in treatment group were significantly shorter than those in control group(P<0.01).The incidences of HFMD(stage 3B or stage 4) and mechanical ventilation in treatment group were significantly lower than those in control group(P<0.01).The incidences of pulmonary edema and pulmonary hemorrhage in treatment group were significantly lower than those in control group(P<0.01).There was no significant difference in the incidences of gastrointestinal bleeding,hypokalemia,hypocalcemia,hyperglycemia,and secondary infection between the two groups(P>0.05).Conclusion:The clinical effect of short-term application of large-dose methylprednisolone is dominant in treatment of HFMD,which is similar to that of low-dose of methylprednisolone,and the method is worthy to be popularized in clinic.