不同剂量置换液连续性血液净化治疗小儿爆发性心肌炎的临床疗效观察

Efficacy Observation of Different Dosage of Replacement Fluid During Continuous Blood Purification for Fulminant Myocarditis Children

目的研究在小儿爆发性心肌炎治疗中选择不同剂量置换液实施连续性血液净化(continuous blood purification,CBP)的价值。方法医院于2016年1月—2019年1月纳入50例爆发性心肌炎患儿开展研究。依据住院号尾数单双号随机选出25例予以常规剂量[20~35 mL/(kg·h)]置换液实施CBP(研究1组),另外25例选择高剂量[45~60 mL/(kg·h)]置换液实施CBP(研究2组),评估两组疗效。结果两组总有效率对比差异不具有统计学意义(P> 0.05);研究2组肌酸激酶同工酶(creatine kinase isoenzyme,CKMB)、肌红蛋白(myoglobin,Mb)及血清肌钙蛋白I(cardiac troponin I,c Tn I)水平,心率(heart rate,HR)、呼吸(respire,R)及射血分数均优于研究1组;研究2组低体温不良反应发生率显著高于研究1组(P <0.05)。结论与常规剂量相比,高置换剂量能够一定改善患儿心肌损伤,有利于生命体征平稳,但是二者疗效相近,且高置换剂量容易引发低体温等不良反应,故临床方案选择时需要注意。

Objective To study the value of different dosage of replacement fluid during continuous blood purification(CBP)for fulminant myocarditis children.Methods 50 fulminant myocarditis children treated from January 2016 to January 2019 in our hospital were selected and randomly assigned to two groups according to odd or even admission number.25 cases of taking the routine dosage of replacement fluid[20~35 mL/(kg·h)]was set as study group 1;25 cases of taking the high dosage of replacement fluid[45~60 mL/(kg·h)]were set as study group 2.Therapeutic effects were probed.Results The total effective rate between groups was not significantly different(P>0.05);CK-MB(creatine kinase-MB),Mb(myoglobin)and cTn I(cardiac troponin I),HR(heart rate),R and ejection fraction levels in study group 2 were better than study group 1;occurrences of hypothermia in study group 2 was significantly higher than study group 1(P<0.05).Conclusion High-dosage replacement fluid can relieve the myocardial damage and stabilize the vital signs,but may increase the occurrences of hypothermia.The proper treatment modes shall be chosen in clinical practice.