大剂量免疫球蛋白联合磷酸肌酸钠治疗小儿急性重症病毒性心肌炎的临床分析

Clinical analysis of high-dose immunoglobulin combined with creatine phosphate in children with acute severe viral myocarditis

目的探讨大剂量免疫球蛋白联合磷酸肌酸钠治疗小儿急性重症病毒性心肌炎(VMC)的临床疗效。方法抽取我院2018年2月-2019年3月收治的60例急性重症VMC患儿,随机分为常规组和联合组,均30例。常规组采用单纯磷酸肌酸钠治疗,联合组在常规组的基础上采用大剂量免疫球蛋白治疗,观察2组疗效及血清心肌损伤指标变化情况。结果治疗14 d后,联合组总有率为96.67%,常规组为76.67%,差异显著(P<0.05)。治疗前,2组c Tn I、LDH、AST、CK及CK-MB水平相似(P>0.05);治疗后,2组上述指标水平均下降,且联合组低于常规组(P<0.05)。联合组给药后心肌酶谱指标水平恢复及临床症状消失时间为(23.35±2.66)d及(10.97±2.54)d,均低于常规组的(34.35±3.55)d及(17.76±2.31)d,差异显著(P<0.05)。常规组2例患儿出现嗜睡,1例胃肠道反应,不良发生率为10%;联合组1例患儿出现血压降低,不良反应发生率为3.33%,差异无统计学意义(P>0.05)。结论大剂量免疫球蛋白联合磷酸肌酸钠能够改善急性重症VMC患儿临床疗效,改善心肌损伤,且较为安全。

Objective To explore the clinical analysis of high-dose immunoglobulin combined with sodium creatine phosphate in the treatment of pediatric acute severe viral myocarditis(VMC).Methods From February 2018 March 2019,60 patients with acute severe VMC were randomly divided into the conventional group and the combined group,and 30 patients had no difference in general information.The conventional group was treated with pure creatine phosphate alone,and the combined On the basis of the previous group,the group was treated with a large dose of immunoglobulin,and the probability of healing and improvement before and after treatment and the changes in the levels of various indicators of myocardial injury detected by serum detection were observed.Results After 14 days of treatment,the probability of recovery and effectiveness of the combined group was 96.67%,and the probability of recovery and effectiveness of the conventional group was 76.67%.The combination group was better than the conventional group(P<0.05).Before treatment,the cTnI and LDH of the conventional group and the combined group The levels of AST,AST,CK and CK-MB are similar(all P>0.05).After treatment,the levels of the above factors in the two groups decreased(P<0.05),and the combined group was lower than the conventional group(P<0.05);The recovery time of Myocardial Zymogram and the disappearance time of clinical symptoms in the combined group were(23.35±2.66)D and(10.97±2.54)d,which were lower than those in the conventional group(34.35±3.55)D and(17.76±2.31)d,with the difference between the two groups(P<0.05);Two children in the conventional group had drowsiness,one had gastroenteric reaction,and the incidence of adverse reactions was 10%;one child in the combined group had decreased blood pressure,and the incidence of adverse reactions was 3.33%.The difference between the two groups was small(P>0.05).Conclusion Large Dose immunoglobulin combined with creatine phosphate can improve the clinical efficacy of acute severe VMC children,improve myocardial damage,and have no toxic effect.