卡托普利联合经鼻持续气道正压通气治疗先天性心脏病并肺炎心力衰竭患儿的临床疗效

Clinical Effect of Captopril Combined With Nasal Continuous Positive Airway Pressure Ventilation in Treating Congenital Heart Disease Children Complicated With Pneumonia and Heart Failure

目的观察卡托普利联合经鼻持续气道正压通气(CPAP)治疗先天性心脏病(CHD)并肺炎心力衰竭患儿的临床疗效。方法选取2013年5月—2015年3月南京医科大学附属无锡人民医院收治的CHD并肺炎心力衰竭患儿120例,根据随机数字表法分为对照组、CPAP组与观察组,各40例。对照组患儿予以面罩或鼻导管吸氧,CPAP组患儿予以经鼻CPAP治疗,观察组患儿在CPAP组基础上加用卡托普利治疗;3组患儿均连续治疗2周。比较3组患儿症状缓解时间、治疗前后肺功能指标〔用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC、最大呼气中期流速(MMEF)、呼气流速峰值(PEF)、二氧化碳分压(Pa CO2)、氧分压(Pa O2)、血氧饱和度(Sa O2)〕、心功能指标〔每搏输出量(SV)、左心室短轴缩短率(LVFS)、左心室射血分数(LVEF)、N末端脑钠肽前体(NT-pro BNP)、肌钙蛋白(c Tn I)〕、血清炎性因子〔白介素6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)〕水平及不良反应/并发症发生情况。结果观察组患儿心率恢复正常时间、肺部湿啰音消失时间及呼吸改善时间短于对照组、CPAP组(P<0.05);CPAP组患儿心率恢复正常时间、肺部湿啰音消失时间及呼吸改善时间短于对照组(P<0.05)。治疗前3组患儿FVC、FEV1、FEV1/FVC、MMEF、PEF、Pa CO2、Pa O2、Sa O2比较,差异无统计学意义(P>0.05);治疗后观察组患儿FVC、FEV1、FEV1/FVC、MMEF、PEF、Pa O2、Sa O2高于对照组、CPAP组,Pa CO2低于对照组、CPAP组(P<0.05)。治疗前3组患儿SV、LVPS、LVEF、NT-pro BNP、c Tn I比较,差异无统计学意义(P>0.05);治疗后观察组患儿SV、LVPS、LVEF高于对照组、CPAP组,NT-pro BNP、c Tn I低于对照组、CPAP组(P<0.05)。治疗前3组患儿血清IL-6、hs-CRP、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后观察组患儿血清IL-6、hs-CRP、TNF-α水平低于对照组、CPAP组(P<0.05)。两组患儿均未发生严重不良反应/并发症。结论卡托普利联合经鼻CPAP治疗CHD并肺炎心力衰竭患儿的临床疗效确切,可改善患儿临床症状、心功能及肺功能,降低血清炎性因子水平,且安全性较高。

Objective To observe the clinical effect of captopril combined with nasal continuous positive airway pressure ventilation in treating congenital heart disease children complicated with pneumonia and heart failure. Methods A total of 120 congenital heart disease children complicated with pneumonia and heart failure were selected in Wuxi People＇s Hospital Affiliated to Nanjing Medical University from May 2013 to March 2015,and they were divided into A group,B group and C＆nbsp;group according to random number table,each of 40 cases. Children of A group received oxygen inhalation by nasal tube or mask, children of B group received nasal continuous positive airway pressure ventilation,while patients of C group received captopril combined with nasal continuous positive airway pressure ventilation; all of the three groups continuously treated for 2 weeks. Remission time of symptoms, index of pulmonary function （ including FVC, FEV1 , FEV1 / FVC, MMEF, PEF, PaCO2 ,PaO2 and SaO2 ）, index of cardiac function （ including SV, LVFS, LVEF, NT-proBNP, cTnI ） and serum inflammatory cytokines（ including IL-6,hs-CRP and TNF-α） levels before and after treatment,and incidence of adverse reactions/ complications were compared among the three groups. Results Recovery time of heart rate,disappearance time of lung wet rale and improvement time of breath of C group were statistically significantly shorter than those of A group and B group （P ﹤ 0. 05）;recovery time of heart rate,disappearance time of lung wet rale and improvement time of breath of B group were statistically significantly shorter than those of A group（ P ﹤ 0. 05）. No statistically significant differences of FVC,FEV1 , FEV1 / FVC,MMEF,PEF,PaCO2 ,PaO2 or SaO2 was found among the three groups before treatment（ P ﹥ 0. 05）;after treatment,FVC,FEV1 ,FEV1 / FVC,MMEF,PEF,PaO2 and SaO2 of C group were statistically significantly higher than those of A group and B group,while PaCO2 of C group was statistically significantly lower than that of A group and B group, respectively（P ﹤ 0. 05）. No statistically significant differences of SV,LVPS,LVEF,NT-proBNP or cTnI was found among the three groups before treatment（P ﹥ 0. 05）;after treatment,SV,LVPS and LVEF of C group were statistically significantly higher than those of A group and B group,while NT-proBNP and cTnI of C group were statistically significantly lower than those of A group and B group after treatment（P ﹤ 0. 05）. No statistically significant differences of serum level of IL-6,hs-CRP or TNF-α was found among the three groups before treatment（P ﹥ 0. 05）,while serum levels of IL-6,hs-CRP and TNF-α of C group were statistically significantly lower than those of A group and B group（P ﹤ 0. 05）. No one of the two groups occurred any severe adverse reactions/ complications. Conclusion Captopril combined with nasal continuous positive airway pressure ventilation has certain clinical effect in treating congenital heart disease children complicated with pneumonia and heart failure, can effectively relive the clinical symptoms,improve the cardiac function and pulmonary function,reduce the serum inflammatory cytokines levels,and is relatively safe.