小剂量多巴胺联合多巴酚丁胺联合常规方案治疗小儿重症肺炎的临床评估

Clinical assessment of low dose of dopamine combined with dobutamine and conventional treatment on children with severe pneumonia

目的:分析小剂量多巴胺联合多巴酚丁胺联合常规方案治疗小儿重症肺炎的临床效果。方法:选取本院收治的重症肺炎患儿218例纳入研究,根据治疗方式不同分为观察组及对照组。对照组接受常规治疗,观察组接受小剂量多巴胺联合多巴酚丁胺联合常规方案治疗,对比两组症状缓解时间、血气指标、炎症因子水平、肺表面活性蛋白水平等差异。结果:观察组治疗后体温消退时间、呼吸困难缓解时间、心率恢复正常时间、肺部啰音消失时间均短于对照组(P<0.05);治疗后3d及7d,观察组动脉血PaO2、HCO3水平高于对照组,PaCO2水平低于对照组(P<0.05);观察组治疗后7d血清IL-1β、IL-6、TNF-α、sICAM-1、CRP水平低于同期的对照组,IL-10水平高于对照组(P<0.05);治疗后7、10、14d观察组的血清SP-A、SP-B、SP-C、SP-D水平值均明显低于对照组(P<0.05)。结论:重症肺炎患儿的治疗中加入小剂量多巴胺及多巴酚丁胺,可促进临床症状的改善、降低全身炎症反应,在优化肺通气换气功能的同时减少肺实质损伤,具有积极的临床意义。

Objective：To analyze the clinical effect of low dose of dopamine combined with dobutamine and conventional treatment on children with severe pneumonia. Methods： A total of 218 cases of children with severe pneumonia treated in our hospital from August 2011 to May 2014 were selected for study and divided into observation group and control group according to different treatment methods. Control group received conventional treatment, observation group received low dose of dopamine combined with dobutamine and conventional treatment, and then differences in symptomatic relief time, blood gas indexes, inflammatory factor levels and pulmonary surfactant protein levels between two groups were compared. Results： After treatment, the temperature subsided time, time of breathing relieved with difficulty, time that heart rate returned to normal and the pulmonary rale disappeared time of observation group were all shorter than those of control group （P〈0.05） at day 3 and 7, PaO2 and HCO3 levels in arterial blood of observation group were higher than those of control group, while PaCO2 level was lower than that of control group （P〈0.05） ; serum IL-113, IL-6, TNF-α, sICAM-1 and CRP levels of observation group at day 7 were lower than those of control group at the same period, while IL-10 level was higher than that of control group （P（ 0.05） at day 7, 10 and 14, serum SP A, SP-B, SP-C and SP D levels of observation group were significantly lower than those of control group （P〈0.05）. Conclusion： Adding low dose of dopamine and dobutamine to treatment of children with severe pneumonia can promote the improvement of clinical symptoms, reduce systemic inflammation, optimize pulmonary ventilation and aeration function while reduce lung parenchyma damage, and it has active clinical significance.