酚妥拉明治疗重症手足口病急性肺水肿的临床研究

CLINICAL STUDY OF PHENTOLAMINE IN TREAMENT OF SEVERE HAND-FOOT-MOUTH DISEASE COMPLICATED WITH ACUTE PULMONARY EDEMA

目的探讨酚妥拉明在重症手足口病急性肺水肿患儿治疗中的心脏保护作用。方法选择重症手足口病并发急性肺水肿患儿100例,随机分为治疗组和对照组各50例。所有患儿均在重症监护室接受呼吸机支持治疗,均给予降颅高压、静脉丙种球蛋白及维持血糖、血压、体温等内环境稳定等常规综合治疗,2组在呼吸机支持的同时,治疗组给予酚妥拉明维持泵点5μg·kg^(-1)·min^(-1),对照组给予米力农5μg/kg缓慢静脉注射,再维持泵点0.5μg·kg^(-1)·min^(-1),2组均在呼吸机支持后6h及72h采血检测,每隔6h记录心率、血压,比较2组在心肌酶、肌钙蛋白、心率、血压等方面的差异。结果治疗组心肌酶、肌钙蛋白、心率、血压方面均低于对照组,呼吸机支持时间、住院时间短于对照组,差异有统计学意义(P<0.01)。结论酚妥拉明治疗重症手足口病急性肺水肿患儿,能更好地保护心脏功能,减轻心脏损害,缩短住院时间,有较好的临床使用价值。

Objective To study the heart protective effect of phentolamine in treatment of children of severe hand foot and mouth disease （HFMD） with acute pulmonary edema. Methods One hundred children of severe HFMD complicated with acute pulmonary edema, were randomly divided into treatment group and control group with 50 cases in each group. All patients were given ventilator support treatment in the ICU, and all were treated with intracranial hypertension, intravenous immunoglobulin and maintaining blood sugar, blood pressure, body temperature and other environmental stability. Simultaneously, treatment group was given phentolamine pump at the speed of 5μg·kg^-1·min^-1, and the control group milrinone pump at the speed of 0.5 μg·kg^-1·min^-1, two groups got blood sampling at the 6 hours and 72 hours after ventilator support. The heart rate and blood pressure were recorded every six hours to compare the difference in the myocardial enzyme, troponin, heart rate and blood pressure of two groups. Results Compared with control group, myocardial enzyme, troponin, heart rate, blood pressure of phentolamine group were lower, and ventilation support time, hospitalization time were shorter, the difference were statistically significant （P 〈 0.01 ）. Conclusion Phentolamine can protect the heart function better in treatment of severe HFMD complicated with acute pulmonary edema, decrease the heart injury, shorten the time of hospitalization, has good clinical value.