本文選題：嬰幼兒 + 重病肺炎合并心力衰竭�。� 參考：《河北醫(yī)科大學》2012年碩士論文

【摘要】：目的：心力衰竭是兒科常見的急癥之一,嬰幼兒期較兒童期更多見。重癥肺炎以及先天性心臟病合并重癥肺炎是嬰幼兒時期發(fā)生急性心力衰竭的常見原因。心力衰竭是指由于心功能的減退,心臟雖經(jīng)發(fā)揮代償能力,仍不能泵出足夠的氧合血,以滿足全身組織代謝需要的一種臨床綜合癥。如果不能夠及時的診斷以及合理的治療,心力衰竭會進一步發(fā)展成為心源性休克,危及患兒生命。本文通過分析和觀察60例重癥肺炎合并心力衰竭患兒的呼吸頻率、心率、肝臟大小、尿量以及BNP的變化情況,來比較兩種治療方案(西地蘭治療方案與米力農(nóng)治療方案)對控制心力衰竭有無差別。 方法：以2010年10月-2011年12月期間我院兒科病房收治的重癥肺炎合并心力衰竭患兒60例為研究對象,對患兒的呼吸頻率、心率、肝臟大小、尿量以及BNP的變化情況進行監(jiān)測。其中男36例,女24例；最小年齡2個月,最大年齡8個月。根據(jù)治療方案的不同,將60例患兒隨機分成兩組,即西地蘭治療組(n=30例),和米力農(nóng)治療組(n=30例)。西地蘭治療組的方案：在常規(guī)治療(吸氧、鎮(zhèn)靜、抗感染)的基礎(chǔ)上加用西地蘭,具體用法是：=2歲,0.03mg/kg。首先應(yīng)給予洋地黃化：首次給予總量的1/2,余量分2次,每隔6小時給予一次。洋地黃化后12小時開始給予維持量,維持量為總量的1/4,每天給予一次,直到心力衰竭糾正。米力農(nóng)組治療的方案：在常規(guī)治療(吸氧、鎮(zhèn)靜、抗感染)的基礎(chǔ)上加用米力農(nóng),具體用法是：首先給予負荷量50ug/kg,5分鐘緩慢靜注,以后每分鐘0.5ug/kg維持.一般每天給予12小時,直到心力衰竭糾正為止。 心力衰竭診斷標準：《第七版兒科學》。并除外先天性心臟病、心律失常、擴張性心肌病等引起的心力衰竭。所有病人入院前均未接受強心藥的治療,入院后20分鐘內(nèi)收集病人的資料,記錄下患兒的呼吸頻率、心率、肝臟大小以及尿量,同時采取患兒的BNP。以后每3小時觀察一次病人,記錄患兒的呼吸頻率、心率、肝臟大小以及尿量情況,直到患兒心力衰竭控制(標準為：患兒的呼吸頻率≤59次/分、心率≤159次/分、肝臟3cm、尿量200ml)。如果患兒入院時的BNP100pg／ml,可在第二天、第四天復(fù)查BNP。同時留取20例健康兒童血的BNP作為對照組。 所有記錄的數(shù)據(jù)用SPSS13.0統(tǒng)計軟件進行統(tǒng)計學處理,先進行正態(tài)分布的檢驗,結(jié)果是p0.1,為偏態(tài)分布,結(jié)果用中位數(shù)表示。組間采用多個獨立樣本非參數(shù)檢驗,P0.05表示差異有統(tǒng)計學意義。 結(jié)果： 1米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒呼吸頻率的影響 米力農(nóng)治療組與西地蘭治療組重癥肺炎合并心力衰竭患兒呼吸頻率得到改善的時間用中位數(shù)表示均為2天兩組比較,結(jié)果P0.05,無統(tǒng)計學意義：米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒的呼吸頻率改善作用無明顯差別。 2米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒心率的影響 米力農(nóng)治療組與西地蘭治療組重癥肺炎合并心力衰竭患兒心率得到改善的時間用中位數(shù)表示均為2天,兩組比較,結(jié)果P0.05,無統(tǒng)計學意義：米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒的心率改善作用無明顯差別。 3米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒肝臟回縮的影響 米力農(nóng)治療組與西地蘭治療組重癥肺炎合并心力衰竭患兒肝臟回縮得到改善的時間用中位數(shù)表示均為2天。兩組比較,結(jié)果P0.05,無統(tǒng)計學意義：米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒的肝臟回縮改善作用無明顯差別。 4米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒尿量的影響 米力農(nóng)治療組與西地蘭治療組重癥肺炎合并心力衰竭患兒尿量恢復(fù)到正常的時間用中位數(shù)表示均為1天。兩組比較,結(jié)果P0.05,無統(tǒng)計學意義：米力農(nóng)治療組與西地蘭治療組對重癥肺炎合并心力衰竭患兒的尿量改善作用無明顯差別。 5臨床上診斷的嬰幼兒重癥肺炎合并心力衰竭患兒的BNP與健康嬰幼兒BNP的關(guān)系 米力農(nóng)治療組嬰幼兒重癥肺炎合并心力衰竭患兒的BNP用中位數(shù)表示為6.050pg/ml,西地蘭治療組嬰幼兒重癥肺炎合并心力衰竭患兒的BNP用中位數(shù)表示為6.200pg/ml,正常嬰幼兒的BNP用中位數(shù)表示為6.550pg/ml,兩組比較,結(jié)果P0.05,無統(tǒng)計學意義：臨床上診斷嬰幼兒重癥肺炎合并心力衰竭患兒的BNP不高于健康嬰幼兒的BNP。 結(jié)論： 1米力農(nóng)治療組對嬰幼兒重癥肺炎合并心力衰竭患兒的呼吸頻率、心率、肝臟回縮、尿量的改善作用與西地蘭治療組對嬰幼兒重癥肺炎合并心力衰竭患兒的改善作用無明顯差別。 2臨床上診斷嬰幼兒重癥肺炎合并心力衰竭的患兒BNP不高,因此,臨床上不能以BNP的高低作為診斷嬰幼兒重癥肺炎合并心力衰竭的金標準。
[Abstract]:Objective: heart failure is one of the most common emergencies in pediatrics. Childhood is more common than childhood. Severe pneumonia and congenital heart disease combined with severe pneumonia are the common causes of acute heart failure in infants. Heart failure means that the heart can not pump enough oxygen because of the impairment of heart function. A clinical syndrome that meets the needs of the body metabolism. If it is not timely diagnosis and reasonable treatment, heart failure will further develop into cardiogenic shock and endanger the life of children. In this article, the respiratory rate, heart rate, liver size and urine volume of 60 cases of severe pneumonia combined with heart failure were analyzed and observed. And the changes of BNP, to compare the difference between the two treatment regimens (the treatment of the drug and Milrinone Treatment) on the control of heart failure.
Methods: 60 children with severe pneumonia and heart failure treated in the pediatric ward of our hospital from October 2010 -2011 to December were studied. The respiratory frequency, heart rate, liver size, urine volume and the changes of BNP were monitored. Among them, 36 males and 24 females, the minimum age of 2 months, and the maximum age of 8 months. 60 children were randomly divided into two groups, namely, the treatment group (n=30), and the Milrinone Treatment Group (n=30). The scheme of the treatment group was added to the routine treatment (oxygen inhalation, sedative, anti infection). The specific usage was =2 years old, and 0.03mg/kg. should be first given to the total amount of 1/2 and remainder for the first time. 2 times, every 6 hours were given once every 6 hours. After 12 hours of yellowing, the amount of maintenance was given, the amount of 1/4 was given, one time every day, until the heart failure was corrected. Milinon was treated with milrinone on the basis of conventional treatment (oxygen inhalation, sedative, anti infection). The specific usage was to give the load of 50ug/kg, 5 points first. The clock is slowly injected, then 0.5ug/kg per minute. Give 12 hours a day until the heart failure is corrected.
The criteria for diagnosis of heart failure: < seventh edition of Pediatrics >. Except for congenital heart disease, arrhythmia, dilated cardiomyopathy, all patients were not treated with cardiac drugs before admission, and the patient's data were collected within 20 minutes after admission to record the frequency, heart rate, liver size and urine volume of the children. The patient was observed every 3 hours after BNP.. The patient's respiratory frequency, heart rate, liver size, and urine volume were recorded until the child's heart failure control (standard: the child's respiratory frequency was less than 59 / sub, the heart rate was less than 159 / sub, the liver 3cm, the urine volume 200ml). If the child was admitted to the hospital, the BNP100pg / ml could be second days, Fourth BNP. was checked in 20 healthy children and BNP was used as control group.
The data of all the records were statistically processed by SPSS13.0 statistical software, and the results were P0.1. The result was a partial distribution. The results were expressed in the median. Multiple independent samples were used for non parametric tests, and P0.05 indicated that the difference was statistically significant.
Result錛，

本文編號：1816993