小剂量甲泼尼龙联合大剂量丙种球蛋白冲击治疗重症手足口病的疗效及对心肺功能的影响

Efficacy and Influence of Cardiorespiratory Function of Methylprednisolone Sodium Succinate Combined with Human Immunoglobulin in the Treatment of Hand-Foot-Mouth Disease in Children

目的:观察小剂量甲泼尼龙琥珀酸钠联合大剂量丙种球蛋白冲击治疗重症手足口病的疗效,并分析对心肺功能的影响。方法:选取2013年7月至2014年7月在我院就诊的重症手足口病患儿189例,应用随机数字表法,将入选患儿随机分为试验组94例和对照组95例。两组患儿均给予常规治疗方法,治疗组在此基础上加用静脉注射用人免疫球蛋白1 g/(kg·d),连用2 d,联合甲泼尼龙琥珀酸钠2 mg/(kg·d),连用3 d,观察并比较两组患儿退热时间、皮疹消退时间、肢体抖动消失时间及平均住院时间,并检测联合治疗3 d后氧分压(Pa O2)、二氧化碳分压(Pa CO2)、氧合指数(OI)等肺功能指标及心率(HR)、左室射血分数(EF%)、心排出量(CO)等心功能指标的改善情况。结果:治疗组退热时间、皮疹消退时间、肢体抖动消失时间及住院时间分别为(3.68±1.21)d、(5.28±0.87)d、(3.81±1.05)d、(9.45±1.87)d,对照组分别为(4.85±1.34)d、(5.71±0.90)d、(4.72±1.18)d、(13.32±2.31)d,两组比较差异有统计学意义(P<0.05)。两组患儿治疗前Pa O2、Pa CO2、OI、HR、EF及CO比较差异无统计学意义(P>0.05),联合治疗3 d后各指标均得到了明显的改善(P<0.05),且治疗组比对照组改善更明显(P<0.05)。结论:在常规治疗基础上,联合使用小剂量甲泼尼龙琥珀酸钠和大剂量丙种球蛋白对重症手足口病具有良好的治疗作用,值得临床推广应用。

Objective： To observe the therapeutic effects of methylprednisolone sodium succinate and human immunoglobulin regimen on children with severe hand-foot-mouth disease,and analysis their influence on cardiopulmonary function. Methods： To collect children with severe hand-foot-mouth disease admitted to our hospital’s department of pediatrics from July 2013 to July 2014,total 189 children. The 189 children were randomly divided into treatment group（ 94 cases） and control group（ 95 cases）. The treatment group was treated with low dose methylprednisolone sodium succinate in combination with human immunoglobulin,while the control group was treated with conventional therapy. Then observe the therapeutic effects of the both groups,and compare the cardiopulmonary function of two groups. Results： The time of antifebrile,deflorescence,limb jitter disappear of two groups and the length of hospital stay were（ 3. 68±1. 21） days,（ 5. 28 ±0. 87） days,（ 3. 81 ±1. 05） days,（ 9. 45 ±1. 87） days in treatment group,and（ 4. 85 ±1. 34） days,（ 5. 71±0. 90） days,（ 4. 72 ± 1. 18） days,（ 13. 32 ± 2. 31） days in control group,respectively. There was a significant difference between two groups（ P〈0. 05）. There was no difference in Pa O2,Pa CO2,OI,HR,EF and CO between two groups before treatment（ P〉0. 05）,but they all improved after treatment（ P〈0. 05）,and there was a significant difference between two groups（ P〈0. 05）.Conclusion： Methylprednisolone sodium succinate combined with human immunoglobulin in the treatment of hand-foot-mouth disease has a better effect than conventional therapy only,and they have an excellent effect on cardiopulmonary function.