小剂量多巴胺、多巴酚丁胺联合治疗 重症肺炎并呼吸功能不全患儿的临床疗效观察

Clinical observation of low-dose dopamine and dobutamine in the treatment of severe pneumonia with respiratory insufficiency

目的探讨小剂量多巴胺、多巴酚丁胺联合治疗重症肺炎并呼吸功能不全患儿的临床疗效。方法前瞻性选取2019年6月至2020年6月湖南省妇幼保健院收治的100例重症肺炎并呼吸功能不全患儿作为研究对象,随机数字表法分为2组,各50例。对照组患儿行常规治疗,研究组在此基础上给予小剂量多巴胺、多巴酚丁胺联合治疗,多巴胺、多巴酚丁胺每分钟2~5μg/kg,连续泵注12 h,每天进行1次,均治疗5 d。比较2组患儿干预效果,治疗前与治疗5 d后2组患儿的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平、血清白细胞介素-6(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)以及基质金属蛋白酶[基质金属蛋白酶-9(MMP-9)和金属蛋白酶组织抑制因子-1(TIMP-1)、MMP9/TIMPI)]水平变化。结果研究组有效率92.00%,高于对照组的80.00%,差异有统计学意义(P<0.05)。治疗前,2组患儿免疫指标、炎性因子和基质金属蛋白酶水平比较,差异均无统计学意义(P>0.05),治疗5 d后,研究组患儿CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、TIMPI水平分别为(69.54±3.65)%、(39.07±2.27)%、1.97±0.21、(143.23±12.17)ng/mL,均高于对照组[(62.76±4.21)%、(32.79±2.18)%、1.43±0.36、(105.54±12.82)ng/mL],CD8^(+)、IL-6、CPR、TNF-α、MMP-9、MMP-9/TIMPI水平分别为(22.76±0.98)%、(13.76±2.45)pg/mL、(10.64±2.59)mg/L、(13.69±1.21)mg/L、(65.34±3.28)ng/mL、0.53±0.08,均低于对照组[(26.87±0.68)%、(56.65±4.98)pg/mL、(28.85±3.21)mg/L、(28.54±3.10)mg/L、(113.76±7.32)ng/mL、1.43±0.09],差异均有统计学意义(P<0.05)。结论采用小剂量多巴胺联合多巴酚丁胺治疗重症肺炎并呼吸功能不全患儿疗效可靠,可改善机体的免疫功能指标,降低炎性因子水平,缓解基质金属蛋白酶导致的损伤,提升整体治疗效果,具有积极的临床应用价值。

Objective To investigate the clinical efficacy of low-dose dopamine and dobutamine in the treatment of severe pneumonia with respiratory insufficiency.Methods From June 2019 to June 2020,100 children with severe pneumonia and respiratory insufficiency admitted to the Hunan Provincial Maternal and Child Health Hospital were prospectively selected as the research objects,and they were divided into 2 groups by a random number table,each group 50 cases.Children in the control group were given conventional treatment.On this basis,the study group was given a combination of low-dose dopamine and dobutamine.Dopamine and dobutamine were injected at 2 to 5μg/kg per minute for 12 hours.It was performed once a day,and both were treated for 5 days.The intervention effect of the two groups of children,before treatment and 5 days after treatment,the levels of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),serum interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)and matrix metalloproteinases[matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1),MMP9/TIMPI)]in the two groups of children were compared.Results The effective rate of the study group was 92.00%,which was higher than 80.00%of the control group,and the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in the levels of immune indexes,inflammatory factors and matrix metalloproteinases between the two groups of children(P>0.05).After 5 days of treatment,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),TIMPI in the study group children were(69.54±3.65)%,(39.07±2.27)%,1.97±0.21,(143.23±12.17)ng/mL,which were all higher than those in the control group[(62.76±4.21)%,(32.79±2.18)%,1.43±0.36,(105.54±12.82)ng/mL],the levels of CD8^(+),IL-6,CPR,TNF-α,MMP-9,MMP-9/TIMPI were(22.76±0.98)%,(13.76±2.45)pg/mL,(10.64±2.59)mg/L,(13.69±1.21)mg/L,(65.34±3.28)ng/mL,0.53±0.08,respectively,which were all lower than those in the control group[(26.87±0.68)%,(56.65±4.98)pg/mL,(28.85±3.21)mg/L,(28.54±3.10)mg/L,(113.76±7.32)ng/mL,1.43±0.09],the differences were statistically significant(P<0.05).Conclusion Low-dose dopamine combined with dobutamine in the treatment of severe pneumonia with respiratory insufficiency can improve the body's immune function indicators and reduce the level of inflammatory factors,alleviate the damage caused by matrix metalloproteinases,and enhance the overall therapeutic effect,with positive clinical value.