小兒重癥肺炎的心功能分析

1、小兒重癥肺炎的心功能分析    小兒重癥肺炎的心功能分析 The Analysis of Heart Function of Severe Pneumonia in Children【中文摘要】 目的:通過觀察肺炎患兒的心肌酶CK-MB值、心臟超聲的EF值、E/A比值、肺動(dòng)脈壓,以及比較去乙酰毛花苷與美托洛爾治療小兒肺炎合并心衰的臨床效果,探討小兒重癥肺炎對(duì)心臟功能的影響。方法:以2008年1月至12月期間,我院兒科確診為肺炎的住院患兒為對(duì)象。在年齡小于1歲的患兒中,隨機(jī)抽取40名患兒做為研究對(duì)象,根據(jù)是否合并心力衰竭,分為兩組,即心衰組(heart f

2、ailure,HF組,n=20)和非心衰組(non -heart failure,non-HF組,n=20),再將心衰組的20名患兒隨機(jī)分為兩組,即去乙酰毛花苷組(n=10)和美托洛爾組(n=10)。40名肺炎患兒中,男孩為23例,占57.5%,女孩為17例,占42.5%,心衰組中,男孩為12例,占60%,女孩為8例,占40%,非心衰組中,男孩為11例,占55%,女孩為9例,占45%,去乙酰毛花苷組與美托洛爾組中,男孩各6例,女孩各4例,男女比例為3:2。肺炎的診斷標(biāo)準(zhǔn)為:(1)癥狀:發(fā)熱、咳嗽、呼吸短促。(2)體征:肺部可聞及固定的中、細(xì)濕啰音?)輔助檢查:胸部X線片顯示有炎性滲出。小兒肺炎

3、合并心力衰竭的診斷標(biāo)準(zhǔn)為:(1)呼吸突然加快,>60次/分。(2)心率突然>180次/分。(3)驟發(fā)極度煩躁不安,明顯發(fā)紺,面色發(fā)灰,指(趾)甲微血管充盈時(shí)間延長(zhǎng)。(4)心音低鈍,奔馬律,頸靜脈怒張。(5)肝臟迅速增大。(6)尿少或無尿,顏面眼瞼或雙下肢水腫。具有前5項(xiàng)者即可診斷為心力衰竭。對(duì)于有原發(fā)性心臟疾病(如:先天性心臟病、心律失常、心源性休克、感染性心內(nèi)膜炎、心肌炎、心肌病、心包炎等)的患兒,不列入本研究對(duì)象。所有患兒均于入院后第二天清晨空腹抽取靜脈血2ml,送我院生化室,由生化分析儀測(cè)定心肌酶,記錄CK-MB值。并于安靜狀態(tài)下,于我院心臟超聲室查心臟超聲,均由同一醫(yī)務(wù)人員

4、操作,記錄EF值、E/A值、肺動(dòng)脈壓力。心衰組的患兒均用心電監(jiān)護(hù)儀實(shí)時(shí)監(jiān)測(cè)心率。記錄去乙酰毛花苷組與美托洛爾組心衰糾正所需的天數(shù)。所有記錄的數(shù)據(jù)用SPSS16.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,并進(jìn)行方差齊性及正態(tài)性的檢驗(yàn),結(jié)果用均數(shù)±標(biāo)準(zhǔn)差( x±s)表示,兩組間均數(shù)的比較采用t檢驗(yàn),p<0.05為差異有顯著性。結(jié)果:1心肌酶CK-MB的變化非心衰組的心肌酶CK-MB為13.90±6.79U/L,心衰組的心肌酶CK-MB為19.07±7.19U/L,兩組均數(shù)比較有顯著差異性(p<0.05)。即心衰組患兒的CK-MB顯著高于非心衰組。2射血分?jǐn)?shù)(EF

5、)的變化非心衰組的EF值為67.96±5.76(%),心衰組的EF值為68.81±5.77(%),兩組均數(shù)比較無顯著差異性(p>0.05)。即心衰組的EF值與非心衰組比較無顯著差異。3 E/A比值的變化非心衰組的E/A比值為1.53±0.35,心衰組的E/A比值為1.42±0.30,兩組均數(shù)比較無顯著差異性(p>0.05)。心衰組的E/A比值與非心衰組比較無顯著差異。4去乙酰毛花苷與美托洛爾治療效果的比較去乙酰毛花苷組糾正心衰的時(shí)間為4.80±2.04天,美托洛爾組糾正心衰的時(shí)間為4.50±1.72天。兩組均數(shù)比較無顯著差

6、異性(p>0.05)。即美托洛爾組糾正心衰的時(shí)間與去乙酰毛花苷組比較無顯著差異。5肺動(dòng)脈高壓的情況非心衰組與心衰組均未發(fā)現(xiàn)有肺動(dòng)脈高壓。結(jié)論:1.小兒輕癥肺炎僅累及呼吸系統(tǒng)本身,重癥肺炎可使心肌細(xì)胞受損,引起心肌酶CK-MB升高。2.小兒重癥肺炎雖可引起心肌損傷,但并不影響心臟的泵血功能。3.與去乙酰毛花苷相比,美托洛爾同樣可以改善小兒肺炎合并心力衰竭的臨床表現(xiàn)?！居⑽恼?Objective: To explore the impact of severe pneumonia in children on cardiac function, by observing CK-MB, E

7、F, E/A ratio, and pulmonary arterial pressure, and comparing the clinical effect of deslanoside and metoprolol treating childhood pneumonia with heart failure.Method:We study the children diagnosed with pneumonia in our hospital from January to December in 2008, and chose forty randomly as object. T

8、hey were divided into two groups, heart failure group(HF group, n=20) and non-heart failure(non-HF group, n=20). The twenty patients in HF group were divided into two groups, deslanoside group(n=10) and metoprolol group(n=10). Among the forty patients, boys were twenty-three(57.5%), girls were seven

9、teen(42.5%). In the HF group, boys were twelve(60%), girls were eight(40%). In the non-HF group, boys were eleven(55%), girls were nine(45%). In the deslanoside group, boys were six, girls were four, and the metoprolol group too. The criteria for pneumonia is that, (1)Symptoms(fever, cough, short of

10、 breath) (2)Signs(medium and fine crackles) (3) Assistant examination(exudation on chest X-rays). The criteria for pneumonia with heart failure in children is that, (1) Respiratory rate is more than sixty per minute. (2) Heart rate is more than one hundred and eighty per minute. (3) Dysphoria, cyano

11、sis, pale, capillary refilling time delayed. (4) Low heart tones, gallop rhythm, distension of jugular vein. (5) The liver increase rapidly. (6) Little or no urine, edema of face, eyelid and lower limb. The patient would be diagnosed with heart failure if he or she accord with the front five items.

12、It is not our object if the patient has primary heart disease such as congenital heart disease, arrhythmia, cardiogenic shock, infective endocarditis, myocarditis, cardiomyopathy, pericarditis, etc. Venous blood samples were collected in the morning after the patients were admitted to the hospital.

13、It was taken to biochemical laboratory to measure the cardiac enzymes. The value of CK-MB was recorded. The patients also have the echocardiography examination by the same doctor. The EF value, E/A ratio and the pulmonary artery pressure were recorded. The heart rate of the patients in HF group were

14、 monitored by the electrocardiogram monitor. The date was recorded when the heart failure was corrected in deslanoside group and metoprolol group. The data were analyzed by spss16.0 and expressed by mean + standard deviation. The difference between two groups is analyzed by T-test. The value of p<

15、;0.05 was regarded as statistical significance.Results:(1)the change of CK-MBThe value of CK-MB is 13.90±6.79U/L in non-HF group, and 19.07±7.19U/L in HF group. There are significant differences between two groups(p<0.05). The value of CK-MB in HF group is higher than non-HF group.(2)th

16、e change of EF valueThe value of EF is 67.96±5.76(%)in non-HF group and 68.81±5.77 ( % ) in HF group. There are no significant differences between two groups(p>0.05). The values of EF are no significant differences between non-HF group and HF group.(3)the change of E/A ratioThe ratio of

17、 E/A is 1.53±0.35 in non-HF group and 1.42±0.30 in HF group. There are no significant differences between two groups(p>0.05). The ratios of E/A are no significant differences between non-HF group and HF group.(4)the effect of deslanoside and metoprololThe date to correct heart failure i

18、s 4.80±2.04 days in deslanoside group and 4.50±1.72 days in metoprolol group. There are no significant differences between two groups(p>0.05). The date to correct heart failure are no significant differences between deslanoside group and metoprolol group.(5)pulmonary hypertensionThere is no pulmonary hypertension in non-HF group or HF group.Conclusion:1. Non-severe pneumonia in children only affect the respiratory system itself, but severe pneumonia can damage the myocardial cell and make the CK-MB arise. 2. The severe pneumonia in children do n