米力农联合酚妥拉明对重症肺炎合并心力衰竭患儿心肌酶谱和心功能的影响

摘要]目的：研究米力农联合酚妥拉明对重症肺炎合并心力衰竭的疗效及心肌酶谱和心功能的影响。方法：选取2014年2月至2018年8月在我院接受治疗的重症肺炎合并心力衰竭患儿68例为研究对象，采用随机数字表法分为对照组和观察组各34例。两组患儿入院后均予以吸氧、止咳、化痰、平喘、抗感染等常规治疗，同时对照组患儿给予米力农治疗，观察组患儿给予米力农联合酚妥拉明治疗，两组患儿均连续治疗1周。观察两组患儿烦躁、肺部啰音、发绀消失时间及肝脏回缩、心衰控制时间等；检测丙氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶MB型同工酶（CK-MB）等心肌酶谱指标水平；观察左心室射血分数（LVEF）、心输出量（CO）、左室舒张早期快速充盈和舒张晚期充盈的峰值比（E/A值）、氨基末端脑钠尿肽（NT-proBNP）等心功能指标的变化；比较两组患儿临床疗效及不良反应。结果：治疗前两组患儿各指标比较差异均无统计学意义（P>0.05），治疗后观察组烦躁、肺部啰音、发绀消失时间及肝脏回缩、心衰控制时间短于对照组，差异有统计学意义（P<0.05）；两组患儿心肌酶谱指标（AST、LDH、CK、CK-MB）以及心功能指标（LVEF、CO、E/A、NT-proBNP）较治疗前均有改善，且观察组改善程度优于对照组（P<0.05）。观察组总有效率为82.35%，高于对照组的52.94%（P<0.05）；两组患儿治疗期间不良反应发生率比较差异无统计学意义（P>0.05）。结论：米力农联合酚妥拉明治疗小儿重症肺炎合并心力衰竭能提高治疗效果，缓解患儿临床症状，降低心肌酶谱，改善心功能，且不增加不良反应，值得临床推广。

Milrinone Combined with Phentolamine on Myocardial Enzymes and Cardiac Function in Children with Severe Pneumonia Complicated with Heart Failure

Abstract] Objective: To investigate the efficacy of milrinone combined with phentolamine in the treatment of severe pneumonia complicated with heart failure and its effects on myocardial enzymes and cardiac function. Methods: Totally 68 children with severe pneumonia complicated with heart failure admitted into our hospital from Feb. 2014 to Aug. 2018 were extracted to be divided into the control group and the observation group via the random number table, with 34 patients in each group. After admission, two groups were given routine treatment such as oxygen inhalation, cough relieving, phlegm resolving, asthma relieving and anti-infection. The control group were treated with milrinone, while the observation group received milrinone combined with phentolamine. Two groups were treated continuously for 1 week. The disappearance time of irritability, lung rales and cyanosis time, control time of liver retraction and heart failure were observed. The indexes of myocardial enzymes such as alanine aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase MB isoenzyme (CK-MB) were detected. Changes of cardiac function indexes such as left ventricular ejection fraction (LVEF), cardiac output (CO), peak ratio of early left ventricular diastolic rapid filling and late diastolic filling (E/A value), amino terminal brain natriuretic peptide (NT-proBNP) of two groups were observed. The clinical efficacy and adverse drug reactions of two groups were compared. Results: There was no significant difference in above indexes between two groups before treatment (P>0.05). After treatment, the disappearance time of irritability, lung rales and cyanosis time, control time of liver retraction and heart failure of the observation group were shorter than those of the control group, with statistically significant difference (P<0.05). The myocardial enzymes (AST, LDH, CK, CK-MB) and cardiac function (LVEF, CO, E/A value, NT-proBNP) were improved in both groups compared with before treatment, and the improvement of the observation group was better than that of the control group (P<0.05). The total effective rate was 82.35% in the observation group, higher than 52.94% in the control group (P<0.05). There was no significant difference in the incidence of adverse drug reactions between two groups (P>0.05). Conclusion: Milrinone combined with phentolamine in the treatment of severe pneumonia complicated with heart failure can improve the therapeutic effects, relieve the clinical symptoms of children, reduce myocardial enzymes levels and improve heart function, without increasing the incidence of adverse drug reactions, which is worthy of clinical promotion.