艾司洛尔联合丙种球蛋白治疗手足口病患儿的临床研究

Clinical trial of esmolol combined with gamma globulin in the treatment of children with hand-foot-mouth disease

目的观察艾司洛尔联合丙种球蛋白治疗手足口病患儿的临床疗效与安全性。方法入选我院接诊的86例手足口病患儿随机分为试验组43例和对照组43例。在常规治疗基础上,对照组给予丙种球蛋白200 mg·kg^(-1)·d^(-1),连用3 d;试验组在对照组的基础上给予艾司洛尔,首先给予0.5 mg·kg^(-1)负荷剂量静脉推注,之后以0.05~0.01 mg·kg^(-1)·min^(-1)持续静脉泵注,直至心率降低趋于稳定后则可停药。比较2组患者的临床疗效、体温恢复正常、疱疹消失时间和治愈时间和治疗前后心输出量(CO)、左心室射血分数(LVEF)、血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、胶原凝集表(Collectin)、Dectin和CD14的变化。结果治疗后,试验组总有效率为93.03%(40例/43例),对照组为72.09%(31例/43例),差异有统计学意义(P<0.05)。试验组体温恢复正常、疱疹消失时间和治愈时间分别为(2.21±0.60),(3.23±0.68),(6.16±1.13)d,对照组分别为(3.51±0.70),(4.37±0.69),(7.70±1.15)d,差异均有统计学意义(均P<0.05)。治疗后,试验组CO和LVEF分别为(4.36±0.51)L·min^(-1),(55.51±6.52)%,对照组分别为(3.38±0.61)L·min^(-1),(49.23±5.19)%;试验组血清CK、CK-MB、Collectin、Dectin和CD14分别为(52.22±7.10)U·L^(-1),(16.30±3.71)U·L^(-1),(41.62±6.63)ng·m L^(-1),(25.99±4.48)pg·m L^(-1),(1.83±0.40)ng·m L^(-1),对照组分别为(61.00±7.61)U·L^(-1),(22.51±3.99)U·L^(-1),(53.38±10.03)ng·m L^(-1),(34.76±6.66)pg·m L^(-1),(2.61±0.50)ng·m L^(-1),差异均有统计学意义(均P<0.05)。试验组与对照组药物不良反应发生率分别为4.65%(2例/43例),6.70%(3例/43例),差异无统计学意义(P>0.05)。结论艾司洛尔联合丙种球蛋白治疗手足口病患儿有良好的临床疗效,安全性可靠,可以改善心功能并降低血清Collectin、Dectin、CD14的表达。

Objective To evaluate the clinical efficacy and safety of esmolol combined with gamma globulin in the treatment of children with hand-foot-mouth disease. Methods Eight-six patients with hand-foot-mouth disease were randomly divided into treatment group（ n =43） and control group（ n = 43）. On the basis of conventional treatment,control group was treated with gamma globulin 200 mg · kg^（-1）· d^（-1）,continuous for 3 d. Treatment group was given esmolol on the basis of control group,0. 5 mg·kg^（-1） load dose was intravenously infused at first,and continuous intravenous infusion was performed at the speed of0. 05-0. 01 mg·kg^（-1）·min^（-1）,until the heart rate tends to be stable,it can stop the medicine. The clinical efficacy,body temperature returned to normal,herpes disappearance time and cure time and the changes of cardiac output（ CO）,left ventricular ejection fraction（ LVEF）,serum creatine kinase（ CK）,creatine kinase isoenzyme（ CK-MB）,Collectin,Dectin and CD14 before and after treatment were compared between the two groups. Results The total effective rates of treatment group and control group were 93. 03%（ 40 cases/43 cases）,72. 09%（ 31 cases/43 cases）,with significant difference（ P〈 0. 05）. The body temperature returned to normal,herpes disappeared time and cure time in treatment group were（ 2. 21 ± 0. 60）,（ 3. 23 ± 0. 68）,（ 6. 16 ± 1. 13） d,significantly shorter than those of control group,which were（ 3. 51 ± 0. 70）,（ 4. 37 ± 0. 69）,（ 7. 70 ± 1. 15） d,all with significant difference（ all P〈 0. 05）. After treatment,the CO,LVEF in treatment group were（ 4. 36 ± 0. 51） L·min^（-1）,（ 55. 51 ± 6. 52） %,significantly higher than those of control group,which were（ 3. 38 ± 0. 61） L·min^（-1）,（ 49. 23 ± 5. 19） %（ P〈 0. 05）.The serum CK, CK-MB, Collectin, Dectin and CD14 in treatment group were（ 52. 22 ± 7. 10） U · L^（-1）,（ 16. 30 ± 3. 71） U·L^（-1）,（ 41. 62 ± 6. 63） ng·m L^（-1）,（ 25. 99 ± 4. 48） pg·m L^（-1）,（ 1. 83 ± 0. 40） ng·m L^（-1）,significant lower than those of control group, which were（ 61. 00 ± 7. 61） U · L^（-1）,（ 22. 51 ± 3. 99） U · L^（-1）,（ 53. 38 ± 10. 03） ng·m L^（-1）,（ 34. 76 ± 6. 66） pg·m L^（-1）,（ 2. 61 ± 0. 50） g·m L^（-1）（ all P〈 0. 05）. The total incidence of adverse drug reactions in treatment group and control group were 4. 65%（ 2 cases/43 cases）,6. 70%（ 3 cases/43 cases）,with no significant difference（ P〉 0. 05）. Conclusion Esmolol combined with gamma globulin in the treatment of children with hand-foot-mouth disease has good clinical efficacy,reliable,can improve cardiac function and reduce serum Collectin,Dectin,CD14 expression.