米力农联合艾司洛尔治疗危重型手足口病的疗效观察

Curative effect of Milrinone combined with Esmolol in treatment of severe hand-foot-and-mouth disease

目的 观察米力农联合艾司洛尔治疗危重型手足口病（HFMD）的临床疗效,以改善危重型HFMD患儿的预后.方法 选择2013年5月至2014年6月徐州市儿童医院重症监护室的82例危重型HFMD患儿为研究对象,采用随机数字表法分为对照组及观察组.对照组予米力农治疗,观察组予米力农联合艾司洛尔治疗.患儿入院后均测定心率（HR）、收缩压（SBP）、心排出量（CO）、左心室射血分数（LVEF）及血清脑利钠肽（BNP）、去甲肾上腺素（NE）.治疗1h及48 h后复查上述指标,比较治疗前后2组患儿各项指标变化情况,判断临床疗效.结果 1.治疗前2组患儿HR,SBP,CO,LVEF,BNP和NE等方面差异均无统计学意义（P均＞0.05）.2.与治疗前比较,治疗1h后2组患儿的HR、SBP和CO、LVEF均改善,差异均有统计学意义（P均＜0.05）;治疗1h后对照组血清BNP及NE和治疗前比较差异无统计学意义（P均＞0.05）,观察组血清BNP及NE较治疗前下降,差异均有统计学意义（P均＜0.05）.治疗48 h后2组患儿各项观察指标均较前改善,差异均有统计学意义（P均＜0.01）.3.与对照组比较,观察组患儿治疗1h后HR、SBP、CO、LVEF和BNP均改善,差异均有统计学意义（t =2.08、2.12、-2.11、-2.37、2.07,P均＜0.05）,而NE无明显变化（t=0.83,P＞0.05）;治疗48 h后观察组各项观察指标均优于对照组,差异均有统计学意义（=3.76、2.48、-2.70、-2.27、5.37、2.74,P均＜0.05）.结论 米力农联合艾司洛尔能显著改善危重型HFMD患儿心脏功能,稳定患儿生命体征,值得临床应用.

Obgective To observe the effect of Milrinone combined with Esmolol in the treatment of severe hand-foot-and-mouth disease （HFMD） so as to improve the prognosis.Methods Eighty-two cases of children with critically severe HFMD,who were hospitalized in the Intensive Care Unit of Xuzhou Children＆#39;s Hospital,were enrolled in the study from may of 2013 to June of 2014,and were randomly divided into a control group and an observation group.The control group was given intravenous Milrinone,and the observation group was given Milrinone combined with Esmolol.The heart rate （HR）,systolic blood pressure （SBP）,cardiac output （CO）,left ventricular ejection fraction （LVEF） and brain natriuretic peptide （BNP）,norepinephrine （NE） were detected on admission and checked again 1 hour and 48 hours again after treatment.The changes in the above indicators were compared before and after therapy to evaluate the clinical curative effect.Results （1） There was no significant difference in the HR,SBP,CO,LVEF,BNP and NE between the 2 groups before treatment（all P 〉 0.05）.（2） The HR,SBP,CO and LVEF of 2 groups were significantly improved after 1 hour treatment compared with those before treatment （all P 〈 0.05）,and the BNP and NE of the control group were not obviously improved compared with those before therapy （all P 〉 0.05）,but the significant changes were seen in the observation group （all P 〈 0.05）.Forty-eight hours after the treatment,all the observed indicators in 2 groups were significantly improved compared with those before treatment（all P 〈 0.01）.（3）Compared with control group,the HR,SBP,CO,LVEF and BNP of the observation group were significantly improved after 1 hour treatment （t =2.08,2.12,-2.11,-2.37,2.07,all P 〈 0.05）,but the NE of the observation group had no obvious improvement （t =0.83,P 〉 0.05）.All the observed indicators of the observation group were significantly improved compared with the control group after 48 hours treatment（t =3.76,2.48,-2.70,-2.27,5.37,2.74,all P 〈 0.05）.Conclusions Milrinone combined with Esmolol can significantly improve the cardiac function and the vital signs of the children with critically severe HFMD,which can be recommended clinically.