米力农联合美托洛尔治疗重症手足口病伴心肺功能衰竭临床研究

Clinical Study of Milrinone Combined with Metoprolol on Cardiorespiratory Failure in Children with Severe Hand Foot and Mouth Disease

目的：观察米力农联合美托洛尔治疗重症手足口病心肺功能衰竭前期（第3期）的临床疗效。方法：选取2012年1月至2014年2月收治的56例重症手足口病3期患儿,随机分为治疗组和对照组各28例。两组患儿均按重症手足口病诊治指南给予氧疗、监测血糖和生命体征、抗病毒、甲泼尼龙、降颅压、丙种球蛋白、米力农[负荷量50μg/kg,10 min缓慢静脉滴注,维持量0.25~0.75μg/（kg·min）用微量泵维持注射]等综合治疗,治疗组除上述综合治疗外口服或鼻饲美托洛尔1~2 mg/（kg·d）,每8 h一次,每日3次,窦性心律且心率下降20%~25%,即血压趋于正常且心率稳定于120~130次/分时停用。观察两组治疗后24 h、48 h、72 h血压、心率及病情加重需机械通气的例数和不良反应。结果：两组患儿的血压、心率在治疗后24 h、48 h、72 h均有下降,但治疗组的血压、心率较对照组改善明显,两组比较差异有统计学意义（P〈0.05）。两组患儿病情加重需机械通气的例数对照组6例（21.4%）,治疗组1例（3.6%）,两组比较差异有统计学意义（χ2=4.37,P〈0.05）。结论：在心肺功能衰竭前期应用米力农联合美托洛尔治疗能改善重症手足口病患儿的心肺功能,有效阻止病情进展,改善预后。

Objective： To observe the effect of milrinone combined with metoprolol on cardiorespiratory failure in children with severe hand foot and mouth disease. Methods： Fifty six children of severe hand foot and mouth disease combined with cardiorespiratory failure were randomly divided into treatment group and control group,each group contained 28 cases. According to the guidelines for the diagnosis and treatment of severe hand foot and mouth disease,all children were treated with oxygen therapy,blood glucose and vital signs monitoring,antiviral treatment,methylprednisolone,decreasing intracranial pressure,gammaglobulin,milrinone（（ 50 μg / kg milrinon were slowly intravenous driped in 10 minutes,to maintain the amount of 0.25 ~ 0.75μg /（ kg·min） with trace injection pump）and other comprehensive treatment. Children in treatment group on the bases of routine treatment were given metoprolol（ 1~2 mg/（ kg·d）） oral or nasogastric treatment. Then we observed the relevant indexes of blood pressure,heart rate changes before and after treatment in two groups. Results： The blood pressure,heart rate of two groups declined after 24 h,48 h,72 h treatment,but the blood pressure,heart rate of treatment group were better than those of control group,the difference were statistically significant（ P〈0.05）; Six cases（ 21.4%） in control group needed mechanical ventilation,1 case（ 3.6%） in treatment group needed mechanical ventilation,the difference was statistically significant（ χ2= 4. 37,P 〈 0. 05）. Conclusion： Milrinone combined with metoprolol in the treatment of severe hand foot and mouth disease combined with cardiorespiratory failure have curative effect,it can hold the progression of disease,improve the prognosis effectively.