TCMP治疗中卡托普利对超声心动图心胸比例和心功能分级的影响分析

目的 研究小儿心动过速心肌病（TCMP）患儿治疗中卡托普利对超声心动图、心胸比例和心功能分级的影响.方法 回顾性分析2011年2月至2016年5月就诊的42例TCMP患儿的临床资料.结果 两组患儿治疗前左心室舒张末期内径（LVEDd）、左心室短轴缩短指数（FS）、左室射血分数（EF）、室间隔厚度（IVST）等超声心动图指标比较无显著性差异（P〉0.05）,治疗后观察组患儿LVEDd、IVST水平明显低于对照组,FS、EF水平明显高于对照组,治疗后两组患儿各超声心动图指标与治疗前均有明显改善（P〈0.05）.两组患儿治疗后心胸比例（CRT）均缩小,治疗后6个月观察组所有患儿CRT恢复正常,而对照组患儿中有9例CRT恢复正常,两组CRT正常率比较差异有统计学意义（P〈0.05）.两组患儿治疗前心功能Ⅰ、Ⅱ、Ⅲ、IV级比较无显著性差异（P〉0.05）,治疗后两组患儿心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级比较有显著性差异（P〈0.05）.两组患者治疗后与治疗前比较均有统计学差异（P〈0.05）.两组患儿治疗前NT-proBNP水平比较无显著性差异（P〉0.05）,治疗后观察组患者NT-proBNP水平明显低于对照组（P〈0.05）,且两组患儿治疗后与治疗前比较均有统计学差异（P〈0.05）.观察组患儿治疗6个月后肝脏缩小≥30%的肝脏缩小率与心电图正常率均明显高于对照组患儿,且差异有统计学意义（P〈0.05）.服用卡托普利的观察组患儿用药过程中未出现肾功能损害和高钾血症.结论 小儿TCMP是一种预后好、可逆性好的心肌病.及早诊断,TCMP患儿治疗首选药物治疗,及时有效的治疗,对疾病的恢复有重大意义.卡托普利联合抗心律失常治疗可使肝脏体积更好的恢复,心律失常和心功能得到更好的恢复,值得临床推广.

Objective To research the influence of echocardiography,cardiothoracic ratio and cardiac function of tachycardia-induced cardiomyopathy of captopril in the treatment of children with tachycardia cardiomyopathy. Methods The clinical data of 42 children with TCMP from February 2011 to May 2016 were analyzed retrospectively. Results The LVEDd、FS、EF、IVST pre-treatment of two groups had no statistical difference（P〉0.05）,the LVEDd、IVST of research group post-treatment were much less than control group,FS、EF were much higher than control group,the every echocardiography of two groups post-treatment were all better than pre-treatment（P〈0.05）.The CRT of two groups post-treatment were all reduced,the normal rate of two groups had statistical difference（P〈0.05）.The Ⅰ,Ⅱ,Ⅲ,Ⅳ grade of two groups pre-treatment had no statistical difference（P〉0.05）,the Ⅰ,Ⅱ,Ⅲ,Ⅳ grade of two groups post-treatment had statistical difference（P〈0.05）,both groups＆#39; cardiac function post-treatment had statistical difference with pre-treatment respectively（P〈0.05）.The NT-proBNP level of two groups pre-treatment had no statistical difference（P〉0.05）,the NT-proBNP level of research group was much less than control group,and had statistical difference with pre-treatment respectively（P〈0.05）.The rate of hepatica shrinkage and normal electrocardiogram of research group after treatment were both higher than control group（P〈0.05）. The patients of research group had no renal damage and hyperkalemia. Conclusion TCMP is a kind of good prognosis and reversible cardiomyopathy in children . Early diagnosis,TCMP treatment of children with the first choice is drug treatment,timely and effective treatment have great significance . Captopril combined with antiarrhythmic therapy can restore the liver volume,arrhythmia and cardiac function better recovery,worthy of clinical promotion.