磷酸肌酸钠对缺氧缺血性脑病并发心肌损伤新生儿心功能及炎症反应的影响

Effect of creatine phosphate sodium on cardiac function and inflammatory response in neonates with hypoxic ischemic encephalopathy combined with myocardial damage

目的探讨磷酸肌酸钠对缺氧缺血性脑病(HIE)并发心肌损伤新生儿心功能及炎症反应的影响。方法将2015年3月至2017年8月平顶山市第一人民医院收治的HIE并发心肌损伤患儿98例分为观察组与对照组,每组49例。2组患儿均给予常规对症支持治疗。在此基础上,对照组患儿予以单唾液酸四己糖神经节苷脂钠20mg,静脉滴注,每日1次;观察组患儿在对照组治疗基础上加用磷酸肌酸钠50mg·kg^-1,静脉滴注,每日1次;2组患儿均治疗10d。比较2组患儿治疗效果及治疗前后心功能指标[舒张早期最大血流速度/舒张晚期最大血流速度(E/A)比值、左心室射血分数(LVEF)]、血清心肌酶谱指标[肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)]、炎症指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平。结果观察组和对照组患儿治疗总有效率分别为95.92%(47/49)、79.59%(39/49),观察组患儿治疗总有效率显著高于对照组(χ^2=6.078,P<0.05)。治疗前2组患儿E/A、LVEF比较差异无统计学意义(P>0.05)。治疗后2组患儿E/A、LVEF均显著高于治疗前(P<0.05),且观察组患儿E/A、LVEF显著高于对照组(P<0.05)。治疗前2组患儿血清CK-MB、CK、IL-6、TNF-α水平比较差异无统计学意义(P>0.05)。治疗后2组患儿血清CK-MB、CK、IL-6、TNF-α水平均低于治疗前(P<0.05);且观察组患儿血清CK-MB、CK、IL-6、TNF-α水平低于对照组(P<0.05)。结论磷酸肌酸钠可显著改善HIE并发心肌损伤患儿心功能,减轻机体炎症反应,提高临床效果。

Objective To investigate the effect of creatine phosphate sodium on cardiac function and inflammatory response in neonates with hypoxic ischemic encephalopathy(HIE) combined with myocardial damage. Methods Ninety-eight cases of HIE complicated with myocardial injury in the First People′s Hospital of Pingdingshan from March 2015 to August 2017 were selected and divided into observation group and control group,with 49 cases in each group.All patients were given routine symptomatic supportive treatment.On this basis,the patients in the control group were given monosialotetrahexosyl ganglioside sodium 20 mg by intravenous drip,once a day for 10 days;on the basis of the treatment of the control group,the patients in the observation group were given creatine phosphate(50 mg·kg^-1 ) by intravenous drip,once a day for 10 days.The treatment effectiveness and the cardiac function indexes of early diastolic maximal blood flow to late diastolic maximal blood flow ratio(E/A) and left ventricular ejection fraction (LVEF),serum myocardial enzymes indexes of creatine kinase isoenzyme (CK-MB) and creatine kinase (CK),inflammation indexes of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α) were compared between the two groups before and after treatment. Results After treatment,the total effective rate of patients in the observation group and control group was 95.92%(47/49) and 79.59%(39/49),respectively;the total effective rate of patients in the observation group was significantly higher than that in the control group (χ^2=6.078, P <0.05).There was no significant difference in the E/A and LVEF between the two groups before treatment ( P >0.05).The E/A and LVEF of patients after treatment were significantly higher than those before treatment in the two groups ( P <0.05);the E/A and LVEF in the observation group were significantly higher than those in the control group after treatment ( P <0.05).There was no significant difference in the serum levels of CK-MB,CK,IL-6 and TNF-α between the two groups before treatment ( P >0.05).After treatment,the serum levels of CK-MB,CK,IL-6 and TNF-α were lower than those before treatment in the two groups ( P <0.05),and the serum levels of CK-MB,CK,IL-6 and TNF-α in the observation group were lower than those in the control group ( P <0.05). Conclusion Creatine phosphate sodium in the treatment of HIE with myocardial damage can significantly improve the clinical effect,improve cardiac function of children,and reduce inflammatory reaction.