监测心排量在重症手足口病患儿中的临床应用

Clinical application of cardiac output monitoring in children with severe hand-foot-mouth disease

目的部分重症手足口病患儿有明显心功能改变,心功能衰竭是其致死的主要原因,对重症患儿进行左心功能检测对其救治具有重要意义。本研究探讨监测重症手足口病患儿心排量的临床应用价值。方法选取2011年4～9月入住儿科重症监护室的重症手足口病患儿107例,临床分期为2、3、4期分别有73、23、11例。采用超声心输出量监测仪(USCOM)床旁监测患儿的心排量,包括心输出量、每搏输出量。其中95例患儿进行了MRI检查,并按照不同MRI结果分组。MRI异常41例(其中9例延髓受累),未见异常54例。比较不同临床分期及不同MRI结果组间患儿心排量情况。结果与临床2、3期患儿比较,临床4期患儿心排量明显降低(P<0.05);心排量在正常、异常MRI组间比较差异无统计学意义,但延髓受累组患儿心排量明显低于其他部位受累组及MRI正常组(P<0.05)。结论心排量明显降低提示病情危重,并提示病变可能已累及脑干的心血管中枢位置,监测心排量对重症患儿的救治具有指导意义。

Objective Significant cardiac dysfunction has been found in children with severe hand-foot-mouth disease and heart failure is the major cause of death in these patients. Evaluation of cardiac function is essential for the treatment of severe cases. This study evaluated the clinical value of cardiac output monitoring in children with severe hand-foot-mouth disease. Methods A total of 107 children with severe hand-foot-mouth disease admitted to the pediatric intensive care unit from April 2011 to September 2011 were enrolled and divided into three groups by clinical stage： 73 cases in stage 2, 23 cases in stage 3 and 11 cases in stage 4. Cardiac output and stroke volume were measured by ultrasonic cardiac output monitors（USCOM）. Ninety-five children received MRI scanning and were grouped according to the results of MRI： 41 cases （medulla oblongata involvements in 9 cases） in abnormal MRI group and 54 cases in normal MRI group. Cardiac output was compared between the children in different clinical stages and between different MRI results. Results Compared with children in clinical stages 2 and 3, cardiac output in children in clinical stage 4 decreased significantly （P 〈 0.05 ）. There was no differences in cardiac output between the normal and abnormal MRI groups, however cardiac output was significantly lower in children with medulla oblongata involvement than in those with other involvements and normal MRI. Conclusions Significant decrease in cardiac output suggests critical conditions and medulla oblongata cardiovascular center involvement in children with severe hand-foot-mouth disease. Dynamic measurement of cardiac output is valuable for treatment of the disease.