硫酸镁早期干预治疗重症手足口病临床观察及对儿茶酚胺水平的影响

Early Intervention for the Treatment of Severe Hand,Foot and Mouth Disease with Magnesium Sulfate and Its Effects on Blood Level of Catecholamine

目的:观察硫酸镁治疗重症手足口病早期(神经系统受累期)患儿的效果及儿茶酚胺等指标的变化,为针对早期重症手足口病患儿儿茶酚胺水平的干预治疗提供参考。方法:选取2013年7月至2015年5月于我院住院治疗的重症手足口病患儿(血糖≥7.8 mmol/L)82例,随机分为对照组40例和观察组42例。对照组给予利巴韦林抗病毒、地塞米松抗炎、甘露醇降颅压,维持水电解质平衡、补充能量,必要时加用呋塞米利尿、肌苷营养心肌等常规治疗;观察组在常规治疗基础上,静脉滴注25%硫酸镁50~60 mg/(kg·d)。两组疗程均为5~7 d。分别于治疗前、治疗72 h后采集静脉血检测白细胞(WBC)、血糖(BG)、肌酸激酶同工酶(CK-MB)、神经元特异性烯醇化酶(NSE)及去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)水平,记录两组患儿神经系统受累持续时间及住院时间,评价疗效。结果:两组患儿均治愈。治疗72 h后,观察组DA、NSE、BG、WBC、CK-MB水平均降低,对照组仅NSE水平降低,且观察组NE、DA、NSE水平低于对照组(P均<0.05)。观察组神经系统受累时间短于对照组(P<0.05)。结论:在常规治疗基础上加用静脉滴注硫酸镁,能降低早期重症手足口病患儿儿茶酚胺水平,减少激素副作用,减少或防止患儿病情进一步恶化。

Objective： To observe the changes of catecholamine and effect of magnesium sulfate for the treatment of severe hand,foot and mouth disease（ HFMD） children with the nervous system involvement（ NSI）,provide a theoretical basis for early effective intervention therapy to catecholamine of severe HFMD children. Methods： Eighty-two cases of children who were diagnosed as severe HFMD and blood glucose ≥7.8 mmol / L were selected in this study. All the children were randomly divided into treatment group and control group,all cases received routine treatment based on their symptoms,intravenous infusion of 25% magnesium sulfate 50 to 60 mg /（ kg·d） was given in the treatment group. Venous blood was sampled before and 72 h after intravenous infusion magnesium sulfate for measurements of white blood cell（ WBC）,blood glucose（ BG）,creatine kinase isoenzyme（ CK-MB）,neuron-specific enolase（ NSE）. Meanwhile,the levels of plasma norepinephrine（ NE）,adrenaline（ E） and dopamine（ DA） were measured. Continuously observed and recorded the duration of neurological involvement and hospitalization time of children in two groups. The curative effect between the two groups was compared. Results： All cases of the two groups of severe HFMD fully recovered and discharged：（ 1） The levels of DA,NSE,BG,WBC,CK-MB were decreased in treatment group,and only the level of NSE decreased in control group,what＇s more the levels of NE,DA,NSE in treatment group were lower than those in control group（ all P〈0.05）. Duration of neurological involvement in the treatment group was shorter than that of control group（ P〈0.05）. Conclusion： Early magnesium sulfate treatment can attenuate acute excessive release of catecholamine as well as the side effects of hormones,and can provide protective effects on myocardial and cerebral lesion induced by virus invasion. This may be helpful to effectively prevent severe HFMD children with NSI from further deterioration.