西藏西部地区儿童高原性心脏病临床分析及前列地尔靶向治疗评价

Clinical Analysis of Children with High Altitude Heart Disease in Western Tibet and Evaluation of Alprostadil Targeted Therapy

目的:探讨西藏西部地区儿童高原性心脏病的临床特点及应用前列地尔靶向治疗的临床疗效及安全性。方法:选择日喀则人民医院儿科2018年1-10月收治的50例高原性心脏病患儿,随机分为观察组和对照组各25例。对照组患儿予以常规治疗:卧床休息,必要时镇静、吸氧、控制感染、利尿减轻心脏负荷、纠正水电解质酸碱平衡紊乱等处理。观察组患儿在常规治疗基础上应用前列地尔(凯时) 5~10 ng/(h·kg)静脉泵入12 h,连续7~15 d。记录治疗前后患儿的血流动力学改变及超声心动图变化。结果:观察组患儿治疗后的肺动脉压下降程度、心脏超声指数上升程度均大于对照组(P均<0. 05),且平均体动脉压治疗前后无明显变化(P>0. 05),未发现明显不良反应。结论:高原性心脏病是西藏西部地区小儿常见的心脏疾病,呼吸道感染为常见诱发因素。前列地尔治疗小儿高原性心脏病,可有效降低肺动脉压力,改善患儿心功能,且无不良反应,初步评估安全性良好。

Objective: To investigate the clinical characteristics of children with high altitude heart disease in Western Tibet and the clinical efficacy and safety of alprostadil targeted therapy. Methods: A total of 50 children with high altitude heart disease admitted into the pediatrics of People’s Hospital of Shigatse from Jan. to Oct. 2018 were extracted to be randomly divided into the observation group and the control group,with 25 cases in each group. The control group was given conventional treatment such as bed rest;if necessary,sedation,oxygen inhalation,infection control,diuresis of reducing heart load,correction of water electrolyte acid-base balance disorder were given. Children in the observation group were given intravenous alprostadil( Kashi) from 5 to 10 ng/( h·kg) for 12 h on the basis of conventional treatment,for the continuous period of 7 to 15 d. Before and after treatment,changes in hemodynamics and echocardiography were recorded. Results: After treatment,the decrease of pulmonary artery pressure and the increase of cardiac ultrasound index in the observation group were greater than those in the control group( P<0. 05),and there was no significant change in mean body arterial pressure before and after treatment( P > 0. 05). No significant adverse drug reactions were observed. Conclusion:High altitude heart disease is a kind of common heart disease in children in Western Tibet,and respiratory infection is the common predisposing factors. For children with high altitude heart disease,alprostadil can effectively decrease the pulmonary artery pressure and improve cardiac function,without any adverse drug reactions. The therapy has higher safety according to the preliminary evaluation.