磷酸肌酸钠联合复合辅酶治疗手足口病心肌损伤的临床研究

Clinical study on creatine phosphate sodium combined with coenzyme complex in treatment of hand-foot-mouth disease complicated with myocardial damage

目的探讨注射用磷酸肌酸钠联合注射用复合辅酶治疗小儿手足口病心肌损伤的临床疗效。方法选取2015年10月—2016年10月在华中科技大学同济医学院附属武汉儿童医院治疗的手足口病心肌损伤患儿86例为研究对象,按照随机数表法将患者分为对照组和治疗组,每组各43例。对照组患儿静脉滴注注射用复合辅酶,1/2~1支,1次/d。治疗组患儿在对照组治疗的基础上静脉输注注射用磷酸肌酸钠,1 g加入到0.9%氯化钠注射液50 m L中,1次/d。两组患儿均连续治疗7 d。观察两组患者的临床疗效,比较两组治疗前后的临床症状改善情况、心功能指标、心电图异常发生率和心肌酶谱指标。结果治疗后,对照组和治疗组临床总有效率分别为93.02%、97.67%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组症状消失时间、心电图恢复时间和住院天数明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者心输出量(CO)和左心室射血分数(LEVF)均显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗后治疗组的心功能指标显著高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者ST-T段改变、房室传导阻滞、窦性心动过速、窦性心动过缓发生率均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗后治疗组心电图异常发生率显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者的磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、羟丁酸脱氢酶(HBDH)和乳酸脱氢酶(LDH)水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗后治疗组心肌酶谱指标水平显著低于对照组,两组比较差异具有统计学意义(P<0.05)。结论注射用磷酸肌酸钠联合注射用复合辅酶治疗小儿手足口病心肌损害的疗效显著,可以有效提高心功能指标,改善心电图异常发生率,降低心肌酶谱水平,安全性好,具有一定的临床推广应用价值。

Objective To explore the clinical effect of Creatine Phosphate Sodium for injection combined with Coenzyme Complex for Injection in treatment of children with hand-foot-mouth disease complicated with myocardial damage. Methods Children（86 cases） with hand-foot-mouth disease complicated with myocardial damage in Wuhan Children＇s Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology from October 2015 to October 2016 were randomly divided into control（43 cases） and treatment（43 cases） groups. Children in the control group were iv administered with Coenzyme Complex for Injection, 1/2 -1 injection, once daily, Patients in the treatment group were iv administered with Creatine Phosphate Sodium for injection on the basis of the control group, 1 g Creatine Phosphate Sodium for injection added into 50 m L 0.9% Na Cl injection, once daily. Children in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and clinical symptom improvement, cardiac function indexes, the incidence of abnormal electrocardiogram, and the myocardial enzyme indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 93.02% and 97.67%, and there were differences between two groups（P〈 0.05）. After treatment, the disappearance time of clinical symptoms, recovery time of electrocardiogram, and hospitalization days in the treatment group were significantly lower than those in the control group（P〈 0.05）. After treatment, CO and LEVF in two groups were significantly increased, and the difference was statistically significant in the same group（P〈 0.05）. And the cardiac function indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups（P〈 0.05）. After treatment, the incidence of abnormal electrocardiogram including the change of ST-T segment, atrioventricular block, sinus tachycardia and sinus bradycardia in two groups were significantly decreased, and the difference was statistically significant in the same group（P〈 0.05）. And the incidences of abnormal electrocardiogram in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P〈 0.05）. After treatment, the levels of CK, CK-MB, HBDH, and LDH in two groups were significantly decreased, and the difference was statistically significant in the same group（P〈 0.05）. And the myocardial enzyme index levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P〈 0.05）. Conclusion Creatine Phosphate Sodium for injection combined with Coenzyme Complex for injection has remarkable effect in treatment of children with hand-foot-mouth disease complicated with myocardial damage, can increase cardiac function indexes, improve the incidence of abnormal electrocardiogram, reduce myocardial enzyme indexes, with good safety, which has a certain clinical application value.