血管活性药物对第3期手足口病患儿病情转归的影响

Effect of vasoactive agents on the prognosis of children in the third stage of hand-foot-mouth disease

摘要:

目的 分析第3期手足口病患儿血管活性药物应用时机对病情转归的影响。方法 回顾性分析2012年4月至2016年9月收治的入院时病情符合第3期手足口病患儿的临床资料。根据入院后血管活性药物（米力农联合酚妥拉明）开始应用的时间，将患儿分为早期组（入院后2 h之内应用，n=32）、中期组（入院后2~6 h之内应用，n=28）、晚期组（入院后6 h之后应用，n=26）。于血管活性药物治疗前及治疗24 h后采集患儿静脉血，检测3组患儿的肌酸激酶同工酶（CK-MB）、肌钙蛋白（TnI）、脑钠肽（BNP）水平。记录3组患儿左心室射血分数（LVEF）、呼吸频率、血压、心率等指标恢复至正常的时间，计算各组治疗72 h内有效率。结果 早期组治疗总有效率高于中期组和晚期组（P < 0.0167）。治疗24 h后，3组患儿心率、血压、呼吸频率、LVEF比较差异有统计学意义（P < 0.05），其中早期组心率、血压、呼吸频率、LVEF的改善最显著（P < 0.0167）。早期组LVEF、呼吸频率、心率、血压恢复至正常时间短于中期组和晚期组（P < 0.0167）。治疗24 h后，早期组BNP水平低于中期组及晚期组（P < 0.05）。结论 危重型手足口病患儿尽早应用血管活性药物能改善心血管功能，降低病情进展风险，改善预后。

Abstract:

Objective To study the effect of the application timing of vasoactive agents on the prognosis of children in the third stage of hand-foot-mouth disease (HFMD). Methods A retrospective analysis was performed on the medical data of children in the third stage of HFMD between April 2012 and September 2016. According to the application time of vasoactive agents (milrinone combined with phentolamine) after admission, the children were divided into an early stage (within 2 hours after admission) group with 32 children, a middle stage (within 2-6 hours after admission) group with 28 children, and a late stage (more than 6 hours after admission) group with 26 children. Venous blood samples were collected before vasoactive agent treatment and after 24 hours of vasoactive agent treatment to measure the levels of creatine kinase-MB (CK-MB), troponin (TnI), and brain natriuretic peptide (BNP). The recovery time of left ventricular ejection fraction (LVEF), respiratory rate, blood pressure, and heart rate were recorded. The response rate to the treatment within 72 hours of treatment was evaluated. Results The early stage group had a significantly higher overall response rate to the treatment than the middle stage and late stage groups (P < 0.0167). After 24 hours of treatment, there were significant differences in heart rate, blood pressure, respiratory rate, and LVEF among the three groups (P < 0.05). The early stage group showed the most significant improvement in these parameters (P < 0.0167). Compared with the middle stage and late stage groups, the early stage group had significantly shorter recovery time of LVEF, respiratory rate, heart rate, and blood pressure (P < 0.0167). After 24 hours of treatment, the early stage group had a significantly lower level of BNP than the middle stage and late stage groups (P < 0.05). Conclusions Vasoactive agents should be given to children with critical HFMD as early as possible to improve cardiovascular function, reduce the risk of disease progression, and improve prognosis.