西地兰预防婴幼儿重症肺炎合并心力衰竭的研究

Research of cedilanid in the prevention of severe pneumonia complicated with heart failure in infants

目的探讨西地兰治疗婴幼儿重症肺炎的疗效及预防心力衰竭的价值。方法选取2019年1月至2020年12月德州市妇幼保健院收治的重症肺炎患儿80例,按随机数字表法分为对照组和观察组,每组40例。对照组给予常规综合治疗,观察组在对照组的基础上加用西地兰治疗(0.01 mg/kg,一次性静脉注射),两组均治疗5 d后观察疗效。比较两组治疗总有效率、治疗期间心力衰竭发生率、症状与体征改善时间;比较两组治疗前后血清炎性反应指标、心肌标志物以及动脉血气指标。结果观察组治疗后总有效率高于对照组、心力衰竭发生率低于对照组[90.0%(36/40)比72.5%(29/40)、32.5%(13/40)比10.0%(4/40)],差异均有统计学意义(χ^(2)=4.02、4.10,P<0.05)。观察组治疗后症状与体征(烦躁消除、呼吸改善、心率改善及肺部啰音消失)改善时间均少于对照组(P<0.05)。观察组治疗后血清降钙素原、N末端脑钠肽前体、心肌肌钙蛋白I、肌酸激酶同工酶-MB水平均低于对照组[(6.15±1.03)μg/L比(10.85±2.12)μg/L、(112.02±30.09)ng/L比(215.39±55.08)ng/L、(0.68±0.17)μg/L比(1.12±0.34)μg/L、(19.05±6.11)U/L比(28.97±7.82)U/L](P<0.05)。观察组治疗后动脉血氧分压、血氧饱和度、氧合指数均高于对照组[(12.24±1.60)kPa比(10.00±1.35)kPa、0.980±0.117比0.915±0.102、(42.09±9.70)kPa比(37.30±9.49)kPa](P<0.05)。结论小剂量西地兰早期应用于重症肺炎患儿中,可有效降低心力衰竭的发生,改善患儿临床症状与血气指标,值得临床推广使用。

Objective To investigate the efficacy and safety of cedilanid in the treatment of severe pneumonia in infants and the value of preventing heart failure.Methods A total of 80 children with severe pneumonia admitted to Dezhou Maternal and Child Health Hospital from January 2019 to December 2020 were selected and randomly divided into the control group and the observation group,with 40 cases in each group.The control group received comprehensive treatment,while the observation group was treated with cedilanid(0.01 mg/kg,one-time intravenous injection)on the basis of the control group.The efficacy of both groups was observed after 5 d of treatment.The incidence of heart failure,correction time of heart failure,improvement time of symptoms and signs,and length of hospitalization time were compared between the two groups;the inflammatory markers,myocardial markers and arterial blood gas indexes were compared between the two groups before and after the treatment.Results The total effective rate in the observation group was higher than that in the control group,and the incidence of heart failure in the observation group was lower than that in the control group:90.0%(36/40)vs.72.5%(29/40),32.5%(13/40)vs.10.0%(4/40),the differences were statistically significant(χ^(2)=4.02,4.10,P<0.05).The improvement time of symptoms and signs(restlessness elimination,respiratory improvement,heart rate improvement and disappearance of rhonchus in lung)in the observation group were less than those in the control group(P<0.05).The levels of procalcitonin(PCT)and N-terminal pro-brain natriuretic peptide(NT-ProBNP),myocardial troponin I(cTnI),and creatine kinase isoenzyme(CK-MB)in the observation group after treatment were lower than those in the control group:(6.15±1.03)μg/L vs.(10.85±2.12)μg/L,(112.02±30.09)ng/L vs.(215.39±55.08)ng/L,(0.68±0.17)μg/L vs.(1.12±0.34)μg/L,(19.05±6.11)U/L vs.(28.97±7.82)U/L,P<0.05.The levels of oxygen partial pressure(PaO2),blood oxygen saturation(SaO2)and oxygenation index(PaO2/FiO2)in the observation group after treatment were higher than those in the control group:(6.15±1.03)μg/L vs.(10.85±2.12)μg/L,(112.02±30.09)ng/L vs.(215.39±55.08)ng/L,(0.68±0.17)μg/L vs.(1.12±0.34)μg/L,(19.05±6.11)U/L vs.(28.97±7.82)U/L,P<0.05.Conclusions Early application of small dose of cedilanid in infants with severe pneumonia can effectively reduce the occurrence of heart failure,improve the clinical symptoms and blood gas indicators,with significant curative effect,which is worthy of promotion.