摘要
目的研究重症手足口病休克的发病机制,探讨更为有效的治疗方法。方法分析2009年3月至2016年6月于我院住院的10例危重症手足口病患儿的临床资料。患儿有创血压监测下血压偏低,对其进行硝普钠试验,试验阳性者使用米力农氯化钠注射液0.75μg/(kg·min)和硝普钠1~4μg/(kg·min)进行治疗,在此过程中,根据患儿血压调整硝普钠和米力农用量,必要时联用去甲肾上腺素,以尽可能维持患儿收缩压在60mmHg以上。观察治疗前、后患儿血压及心功能的变化情况。结果10例患儿硝普钠试验均阳性,其中1例肺出血患儿经积极抢救无效死亡。在联合使用米力农和硝普钠后,9例患儿治疗后1、2、4、6h的收缩压及舒张压明显高于治疗前(P<0.05),治疗后8、10h的收缩压及舒张压略高于治疗前(P>0.05)。患儿心功能监测时间为治疗后3.5h。治疗后,患儿的LVEF、CO及SV明显高于治疗前(P<0.05)。结论应用硝普钠判别和治疗重症手足口病休克患儿的效果显著,可使患儿平稳地度过休克期,为抢救危重症手足口病患儿的生命创造更多的机会,明显降低患儿的死亡率。
Objective To study the pathogenesis of shock in children with severe hand-foot-and-mouth disease so as to explore more effective treatment methods.Methods The clinical data of 10 cases of children with severe hand-foot-and-mouth disease hospitalized in our hospital from March 2009 to June 2016 were analyzed.The children with low blood pressure under invasive blood pressure monitoring were tested with sodium nitroprusside,the patients with positive results were treated with milrinone sodium chloride injection[0.75μg/(kg·min)]and sodium nitroprusside[1-4μg/(kg·min)].During this process,the dosage of sodium nitroprusside and milrinone was adjusted according to the blood pressure of the children,and norepinephrine was used when necessary to maintain the systolic blood pressure above 60 mmHg.The changes of blood pressure and cardiac function were observed before and after treatment.Results All the 10 cases had positive results of sodium nitroprusside test,and 1 case died of pulmonary hemorrhage after failure of active rescue.After the combined use of milrinone and sodium nitroprusside,the systolic and diastolic blood pressures of 9 children at 1,2,4 and 6 hours after treatment were significantly higher than those before treatment(P<0.05),while the systolic and diastolic blood pressures at 8 and 10 hours after treatment were slightly higher than those before treatment(P>0.05).The monitoring time of cardiac function was 3.5 hours after treatment.After treatment,the LVEF,CO and SV in children were significantly higher than those before treatment(P<0.05).Conclusion The application of sodium nitroprusside in discriminating and treating shock in children with severe hand-foot-mouth disease has a significant effect.It can make the children survive the shock in period smoothly,create more chances for rescuing the life of children with severe hand-foot-mouth disease,and significantly reduce the mortality.
作者
周占青
郝建华
ZHOU Zhan-qing;HAO Jian-hua(Children's Hospital of Kaifeng City,Kaifeng 475000,China)
出处
《临床医学研究与实践》
2019年第22期109-110,共2页
Clinical Research and Practice
关键词
手足口病
休克
动态血压
心功能
hand-foot-and-mouth disease
shock
dynamic blood pressure
cardiac function
