右美托咪定治疗小儿重症肺炎合并心力衰竭的临床研究

Clinical study on dexmedetomidine in treatment of pediatric severe pneumonia with heart failure

目的探讨盐酸右美托咪定注射液治疗小儿重症肺炎合并心力衰竭的临床疗效。方法选取2012年11月—2015年2月天津市宁河县医院儿科收治的重症肺炎合并心力衰竭患儿78例,随机分为对照组（42例）和治疗组（36例）。对照组给予常规治疗,治疗组在对照组治疗基础上静脉泵入盐酸右美托咪定注射液1μg/kg,10 min推注完毕,然后盐酸右美托咪定注射液再以0.2~0.5μg/（kg·h）维持泵入,直至心衰纠正。比较两组治疗前后的心衰临床监测指标、心肌损害监测指标和小儿危重病例评分（PCIS）。结果治疗后,两组患儿的心率、肌酸激酶同工酶（CK-MB）、肌钙蛋白I（c Tn I）显著下降,心脏指数（CI）、左心室射血分数（LVEF）、心脏舒张早期心室充盈速度最大值/舒张晚期心室充盈速度最大值（E/A）均明显升高,同组治疗前后差异具有统计学意义（P〈0.05）;并且治疗组这些指标的改变程度优于对照组,两组比较差异具有统计学意义（P〈0.05）。治疗后,两组患儿的PCIS评分均明显升高,同组治疗前后差异具有统计学意义（P〈0.05）;并且治疗组PCIS评分的改变程度优于对照组,两组比较差异具有统计学意义（P〈0.05）。结论盐酸右美托咪定注射液可用于小儿重症肺炎合并心力衰竭的治疗,降低心率,稳定血流动力学,减轻炎性因子和缺血再灌注损伤对心肌细胞的损伤,值得在儿科领域推广应用。

Objective To observe the efficacy of Dexmedetomidine Hydrochloride Injection in treatment of pediatric severe pneumonia with heart failure. Methods Children（78 cases） with severe pneumonia and heart failure in Department of Pediatrics of Tianjin Ninghe Hospital from November 2012 to February 2015 were randomly divided into control group（42 cases） and treatment group（36 cases）. Children in the control group were treated with conventional treatment. Children in the treatment group were iv pump administered with Dexmedetomidine Hydrochloride Injection 1 μg/kg during 10 min on the basis of control group, and then given 0.2 — 0.5 μg/（kg·h） through continuous iv pump until heart failure correction. Heart failure, myocardial damage index, and pediatric clinical Illness score（PCIS） in two groups before and after treatment were compared. Results After treatment, heart rate, CK-MB, CTn I, CI, LVEF, and E/A in two groups were significantly decreased, and the difference was statistically significant in the same group（P〈0.05）. And these indicators in treatment group improved better than those in the control group, with significant differences between two groups（P〈0.05）. After treatment, PCIS in two groups were obviously increased, and the difference was statistically significant in the same group（P〈0.05）. And these indicators in treatment group improved better than those in the control group, with significant difference between two groups（P〈0.05）. Conclusion Dexmedetomidine Hydrochloride Injection has good clinical efficacy in treatment of pediatric severe pneumonia with heart failure, can significantly decrease heart rate, keep hemodynamics, and reduce the injury of inflammatory factor and ischemia reperfusion injury aginst myocardial cells, which has a certain clinical application value in the field of pediatrics.