甲基泼尼松龙联合肝素治疗儿童重型腹型紫癜的临床观察

目的 观察甲基泼尼松龙联合小剂量肝素治疗腹型过敏性紫癜的疗效.方法 选择2006年1月至2007年12月收住的83例腹型过敏性紫癜患儿随机分为氢化可的松治疗组(A组)、甲基泼尼松龙治疗组(B组)、甲基泼尼松龙联合肝素治疗组(C组).A组应用氢化可的松4～8 mg/kg,加入5%葡萄糖盐水100 ml中静脉点滴,每天1次.7～14 d后改为泼尼松口服并逐渐减量;B组应用甲基泼尼松龙2～4 mg/kg,加入5%葡萄糖盐水100ml中静脉点滴,7～14 d后改为泼尼松口服;C组在B组的基础上给予肝素钠按0.25～0.75 mg/(kg·d)加入5%葡萄糖盐水100 ml中静脉点滴7～10 d,治疗过程中和治疗后观察皮疹、腹痛、消化道出血等临床症状的改变,记录疾病反复率、合并肾损害病例尿常规恢复时间以及水钠潴留、电解质紊乱、出血等不良反应.结果 甲基泼尼松龙联合肝素治疗组在皮疹消退、腹痛缓解及消化道出血停止时间、尿检恢复正常时间均优于氢化可的松组及单纯甲基泼尼松龙组,疾病反复率也低于上述两组.结论 甲基泼尼松龙联合肝素治疗腹型过敏性紫癜在控制症状、降低反复率等方面疗效优于氢化可的松组及甲基泼尼松龙组,无明显不良反应,为治疗重型腹型过敏性紫癜的理想方案.

Clinical observation of about heavy abdomen type of anaphylactoid purpura treated hy methylprednisolone associate with heparin

Objective To observe the curative effect about heavy abdomen type of anaphylactoid pur-pura treated by Methylprednisolone associate with Heparin. Methods Randomly divided eighty three children with heavy abdomen type of anaphylactoid purpura who treated in department of pediatrics of the first hospital affiliated to Kunming medical college from January, 2006 to december, 2007 into group A (treated by Hydro-cortisone) and group B (treated by Methylprednisolone) and group C(treated by Methylprednisolone associate with Heparin). Group A treated by mainline Hydrocortisone dose of 5～8 mg/kg body weight once a day,mixed into 100ml 5% glucose injection, after 7～14 days later, instead of take orally Predisone tablet and de-grees dose by gradually. Group B treated by mainline Methylprednisolone dose of 2～4 mg/kg body weight once a day, mixed into 100ml 5% glucose injection, after 7～14 days later, instead of take orally Predisone tablet, and group C treated by Methylprednisolone by oneself (dose like group B) associate with mainline Hep-arin (dose of 0.25～0.75 mg/kg body weight once a day, mixed into 100ml 5% glucose injection) 7～10 days. Observe clinic symptomatic like as tetter, bellyache, entron hemorrhage when treatment of every group. Contrast reiteration rate of anaphylaetoid purpura, and the period of urine test get hack normal which cases with kidney tamper. Contrast these medication' s side effect such as resort of natrium and water, elec-trolyte turbulence, hemorrhage and so on. Results Group C (treated by Methylprednisolone associate with Heparin) is better then group A (treated by Hydrocortisone) and group B (treated by Methylprednisolone by oneself) in eliminate tetrer and release bellyache. The less period of group C need to treatment entron hemor-rhage and urine test get hack normal. And thereiteration rate is less of group C than group A and group B.Conclusion Methylprednisolone in association with Heparin to treat heavy abdomen type of anaphylactoid purpura is better than hydrocortisone and Methylprednisolone by oneself in controling symptom, reduing reiter-ation rate and more less side effect. So methylprednisolone in association with Heparin to treat of heavy ab-domen type of anaphylactoid purpura is a ideal project.