先天性心臟病肺炎合并心力衰竭患兒霧化硝普鈉臨床療效觀察
發(fā)布時(shí)間：2018-07-24 18:45
【摘要】：目的：目前國(guó)內(nèi)嬰幼兒死因中,先天性畸形己上升至首位,而先天性心臟�。╟ongenital heart diseases,CHD）又占主要成分，嚴(yán)重影響患兒的正常生長(zhǎng)發(fā)育,若不及時(shí)行手術(shù)治療,就會(huì)因反復(fù)呼吸道感染、肺動(dòng)脈高壓或心力衰竭而失去治療的最佳時(shí)機(jī)。而先心病患兒肺炎合并心衰是兒科重癥監(jiān)護(hù)病房（PICU）中最常見(jiàn)的危重癥之一。在先心病肺炎合并心衰的發(fā)病機(jī)制中，肺動(dòng)脈高壓早已得到肯定，目前尚無(wú)有效降低肺動(dòng)脈高壓的藥物應(yīng)用于臨床。硝普鈉是常用的血管擴(kuò)張藥物和外源性一氧化氮供體，在應(yīng)用其霧化吸入方面,國(guó)外的學(xué)者進(jìn)行動(dòng)物試驗(yàn)比較多。本文通過(guò)觀察分析本院80例肺炎合并心衰的先天性心臟病患兒硝普鈉霧化治療后臨床體征、肱動(dòng)脈血壓及CRP數(shù)值變化程度來(lái)進(jìn)一步評(píng)估霧化硝普鈉的療效及其對(duì)體循環(huán)動(dòng)脈壓的影響，為其臨床應(yīng)用提供新的途徑和理論依據(jù)。 方法：以2010年3月-2011年12月期間，我院兒科病房收治的先心病肺炎合并心衰患兒80例為研究對(duì)象，入選標(biāo)準(zhǔn)為符合小兒心力衰竭診斷標(biāo)準(zhǔn)的先天性心臟病肺炎患兒，入院后均經(jīng)心臟彩超證實(shí)患有先天性心臟病合并肺動(dòng)脈高壓：肺動(dòng)脈收縮壓（PASP）30mmHg(4Kpa)或肺動(dòng)脈平均壓（PAMP）20mmHg(2.67Kpa)。其中男42例，女38例；年齡2月～6月37例，6月～1歲26例，1～2歲17例。先天性心臟病類型：?jiǎn)渭兎块g隔缺損（ASD）及單純室間隔缺損(VSD)41例，房間隔缺損合并室間隔缺損23例，動(dòng)脈導(dǎo)管未閉（PDA）10例，法洛四聯(lián)癥（TOF）6例。80例患兒入院前均未接受任何特殊治療，入院后將其隨機(jī)分為兩組，即常規(guī)治療組（n=40例）和硝普鈉霧化組（n=40例），兩組之間年齡、性別、先心病類型及肺動(dòng)脈壓力之間均無(wú)顯著差異，具有可比性，常規(guī)治療組給予鎮(zhèn)靜、吸氧、強(qiáng)心、利尿、改善循環(huán)、抗感染等常規(guī)治療，硝普鈉霧化組即在常規(guī)治療的基礎(chǔ)上加用硝普鈉霧化吸入（生理鹽水2ml+硝普鈉5mg/次2-3次/日）。由同一測(cè)量人員使用同一聽(tīng)診器、秒表及標(biāo)尺測(cè)定患兒自入院第一日至出院日的呼吸、心律及肝臟觸診大小，每天測(cè)量數(shù)次，記錄其數(shù)值及恢復(fù)至正常水平（即小于診斷標(biāo)準(zhǔn)中各指標(biāo)的水平）所需的時(shí)間。并由同一專業(yè)人員使用同一臺(tái)式水銀血壓計(jì)測(cè)量患兒霧化硝普鈉前、中、后的肱動(dòng)脈血壓水平，為便于表示取其平均動(dòng)脈壓即舒張壓+1/3脈壓差表示，記錄其值大小。兩組患兒自入院第一日起每日一次指端采血，測(cè)其CRP數(shù)值并記錄（以CRP8mg/L為異常），檢測(cè)時(shí)間為晨起7-9點(diǎn)。所有數(shù)據(jù)用SPSS13.0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)分布的檢驗(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)，兩組以上的比較采用多個(gè)均數(shù)比較的方差分析，P0.05表示差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：常規(guī)治療組40例患兒，，呼吸頻率快持續(xù)時(shí)間為（44.29±5.17）h，心率快持續(xù)時(shí)間為（50.00±6.96）h，硝普鈉霧化組40例患兒，其值分別為（24.56±5.14）h和（32.60±4.67）h，兩組分別比較均有顯著差異（P0.01）,提示霧化硝普鈉可有效降低患兒的呼吸頻率及心率。所觀察測(cè)量的另一個(gè)指標(biāo)肝臟觸診腫大持續(xù)時(shí)間，常規(guī)治療組40例為（40.21±7.56）h，硝普鈉霧化組40例為（44.13±8.36）h，兩組之間比較有顯著性差異（P0.05），此結(jié)果提示霧化硝普鈉對(duì)腫大肝臟的回縮亦有促進(jìn)作用。硝普鈉霧化組40例患兒中，平均肱動(dòng)脈壓霧化前為（64.35±3.08）mmHg,開(kāi)始霧化后5min為（64.48±3.37）mmHg,停霧化后5min為（64.55±3.97）mmHg，三組之間比較無(wú)顯著性差異（P0.05），即硝普鈉霧化吸入對(duì)體循環(huán)動(dòng)脈平均壓影響不大。常規(guī)治療組CRP數(shù)值高持續(xù)時(shí)間為（7.60±1.25）天，硝普鈉霧化組為（7.44±1.21）天，兩組比較無(wú)顯著差異（P0.05）,提示硝普鈉霧化治療對(duì)肺炎的感染過(guò)程無(wú)明顯影響。 結(jié)論： 1硝普鈉霧化可有效降低先心病肺炎心衰患兒的呼吸頻率。 2硝普鈉霧化可有效降低先心病肺炎心衰患兒的心率。 3硝普鈉霧化對(duì)先心病肺炎心衰患兒腫大肝臟的回縮起促進(jìn)作用。 4硝普鈉霧化降肺動(dòng)脈壓力的同時(shí)不影響體循環(huán)平均動(dòng)脈壓，安全性高。 5硝普鈉霧化對(duì)先心病肺炎心衰患兒的肺炎感染過(guò)程無(wú)影響。 因此，先天性心臟病肺炎合并心力衰竭患兒的治療決策中，可在常規(guī)治療的基礎(chǔ)上加用硝普鈉的霧化，這對(duì)早期緩解患兒心力衰竭癥狀有明確的療效，且操作方便，安全性高。
[Abstract]:Objective: in the current cause of infant death, congenital malformation has risen to the first, and congenital heart diseases (CHD) is the main component, which seriously affects the normal growth and development of the children. If no surgical treatment is performed in time, the best treatment will be lost due to recurrent respiratory infection, pulmonary hypertension or heart failure. Pneumonia combined with heart failure in children with congenital heart disease is one of the most common critical diseases in the pediatric intensive care unit (PICU). In the pathogenesis of heart failure with congenital heart disease, pulmonary hypertension has long been affirmed. At present, there is no effective drug to reduce pulmonary hypertension. The source of nitric oxide donor, in the application of atomization inhalation, the foreign scholars conducted more animal tests. In this paper, the clinical signs, the brachial artery blood pressure and the CRP value changes were observed and analyzed to evaluate the efficacy of the nebulized sodium nitroprusside in 80 children with congenital heart disease with heart failure in our hospital. And its effect on systemic circulation arterial pressure, and provide a new way and theoretical basis for its clinical application.
Methods: 80 children with congenital heart disease and heart failure treated in the pediatric ward of our hospital from March 2010 -2011 to December were selected as the children with congenital heart disease pneumonia in accordance with the diagnostic criteria of children's heart failure. All patients were confirmed to have congenital heart disease with pulmonary artery hypertension after admission. Systolic pressure (PASP) 30mmHg (4Kpa) or mean pulmonary artery pressure (PAMP) 20mmHg (2.67Kpa). Among them, there were 42 males and 38 females, 37 cases of age from February to June, 26 cases from June to 1 years, 17 cases of 1~2 years, and 41 cases of atrial septal defect (ASD) and simple ventricular septal defect (VSD), 23 cases of atrial septal defect combined with ventricular septal defect, and patent ductus arteriosus closure. PDA) 10 cases, 6 cases of tetralogy of Fallot (TOF) had not received any special treatment before admission. After admission, they were randomly divided into two groups, namely, the routine treatment group (n=40) and sodium nitroprusside atomization group (n=40). There was no significant difference between the two groups between the age, sex, the type of congenital heart disease and the pulmonary artery pressure, which was comparable in the routine treatment group. Sedative, oxygen inhalation, cardio, diuresis, improvement of circulation, anti infection and other routine treatment, sodium nitroprusside atomization inhalation with sodium nitroprusside (2ml+ sodium nitroprusside 5mg/ times 2-3 times per day) on the basis of conventional treatment. The same surveyor used the same stethoscope, stopwatch and scale to determine the respiratory rate of the children from the first day to the discharge day. The law and the size of the liver palpation were measured several times a day, and the time needed to record its value and restore to the normal level (that is, the level below the diagnostic criteria). And the same professional mercury sphygmomanometer was used to measure the blood pressure level of the brachial artery before and after atomization of sodium nitroprusside, in order to facilitate the mean arterial pressure. The diastolic pressure +1/3 pulse pressure difference was expressed and recorded the value of the value. Two groups of children from the first day from admission to the first day of blood sampling, measured its CRP value and recorded (with CRP8mg/L as abnormality), the detection time was 7-9 in the morning. All data were statistically processed with SPSS13.0 statistical software, and the test of homogeneity of variance and normal distribution, the results were all used The number of standard deviations (X + S) indicated that the comparison of the average number between the two groups was compared with the t test, and the comparison of the two groups was compared with the analysis of the variance of multiple mean numbers, and the difference was statistically significant in P0.05.
Results: 40 children in the routine treatment group, the fast duration of respiratory frequency was (44.29 + 5.17) h, the fast duration of heart rate was (50 + 6.96) H and 40 cases of sodium nitroprusside group were (24.56 + 5.14) H and (32.60 + 4.67) h respectively, and there were significant differences (P0.01) in the two groups respectively (P0.01), suggesting that nebulized sodium nitroprusside could effectively reduce the respiratory rate of children. And heart rate. Another indicator of measurement of liver palpation and swelling duration, 40 cases (40.21 + 7.56) h in the conventional treatment group and 40 cases (44.13 + 8.36) h in the sodium nitroprusside group (44.13 + 8.36) h, there was a significant difference between the two groups (P0.05). The results suggested that the atomization of sodium nitroprusside could also promote the retracting of the large liver. The sodium nitroprusside atomization group had 40 children. The average brachial artery nebulization was (64.35 + 3.08) mmHg before atomization, and 5min was (64.48 + 3.37) mmHg after atomization, and 5min was (64.55 + 3.97) mmHg after atomization. There was no significant difference between the three groups (P0.05), that is, the mean pressure of the body circulatory artery was not significant with the atomization inhalation of sodium nitroprusside. The high duration of CRP values in the routine treatment group was (7.60 + 1.25) days. Sodium prusside atomization group was (7.44 + 1.21) days, there was no significant difference between the two groups (P0.05), suggesting that atomization treatment with sodium nitroprusside did not significantly affect the infection process of pneumonia.
Conclusion:
1 sodium nitroprusside atomization can effectively reduce the respiratory rate of children with CHF.
2 sodium nitroprusside atomization can effectively reduce the heart rate of children with CHF.
3 sodium nitroprusside atomization promotes the enlargement of liver in children with congenital heart disease and pneumonia with heart failure.
4 nitroprusside atomization reduces pulmonary artery pressure without affecting the mean arterial pressure of systemic circulation.
5 sodium nitroprusside atomization has no effect on pneumonia infection in children with congenital heart disease and pneumonia.
Therefore, in the treatment decision of children with congenital heart disease pneumonia and heart failure, the atomization of sodium nitroprusside can be added on the basis of conventional treatment. It has a clear effect on early relieving the symptoms of heart failure in children, and it is easy to operate and has high safety.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.4
本文編號(hào)：2142301
[Abstract]:Objective: in the current cause of infant death, congenital malformation has risen to the first, and congenital heart diseases (CHD) is the main component, which seriously affects the normal growth and development of the children. If no surgical treatment is performed in time, the best treatment will be lost due to recurrent respiratory infection, pulmonary hypertension or heart failure. Pneumonia combined with heart failure in children with congenital heart disease is one of the most common critical diseases in the pediatric intensive care unit (PICU). In the pathogenesis of heart failure with congenital heart disease, pulmonary hypertension has long been affirmed. At present, there is no effective drug to reduce pulmonary hypertension. The source of nitric oxide donor, in the application of atomization inhalation, the foreign scholars conducted more animal tests. In this paper, the clinical signs, the brachial artery blood pressure and the CRP value changes were observed and analyzed to evaluate the efficacy of the nebulized sodium nitroprusside in 80 children with congenital heart disease with heart failure in our hospital. And its effect on systemic circulation arterial pressure, and provide a new way and theoretical basis for its clinical application.
Methods: 80 children with congenital heart disease and heart failure treated in the pediatric ward of our hospital from March 2010 -2011 to December were selected as the children with congenital heart disease pneumonia in accordance with the diagnostic criteria of children's heart failure. All patients were confirmed to have congenital heart disease with pulmonary artery hypertension after admission. Systolic pressure (PASP) 30mmHg (4Kpa) or mean pulmonary artery pressure (PAMP) 20mmHg (2.67Kpa). Among them, there were 42 males and 38 females, 37 cases of age from February to June, 26 cases from June to 1 years, 17 cases of 1~2 years, and 41 cases of atrial septal defect (ASD) and simple ventricular septal defect (VSD), 23 cases of atrial septal defect combined with ventricular septal defect, and patent ductus arteriosus closure. PDA) 10 cases, 6 cases of tetralogy of Fallot (TOF) had not received any special treatment before admission. After admission, they were randomly divided into two groups, namely, the routine treatment group (n=40) and sodium nitroprusside atomization group (n=40). There was no significant difference between the two groups between the age, sex, the type of congenital heart disease and the pulmonary artery pressure, which was comparable in the routine treatment group. Sedative, oxygen inhalation, cardio, diuresis, improvement of circulation, anti infection and other routine treatment, sodium nitroprusside atomization inhalation with sodium nitroprusside (2ml+ sodium nitroprusside 5mg/ times 2-3 times per day) on the basis of conventional treatment. The same surveyor used the same stethoscope, stopwatch and scale to determine the respiratory rate of the children from the first day to the discharge day. The law and the size of the liver palpation were measured several times a day, and the time needed to record its value and restore to the normal level (that is, the level below the diagnostic criteria). And the same professional mercury sphygmomanometer was used to measure the blood pressure level of the brachial artery before and after atomization of sodium nitroprusside, in order to facilitate the mean arterial pressure. The diastolic pressure +1/3 pulse pressure difference was expressed and recorded the value of the value. Two groups of children from the first day from admission to the first day of blood sampling, measured its CRP value and recorded (with CRP8mg/L as abnormality), the detection time was 7-9 in the morning. All data were statistically processed with SPSS13.0 statistical software, and the test of homogeneity of variance and normal distribution, the results were all used The number of standard deviations (X + S) indicated that the comparison of the average number between the two groups was compared with the t test, and the comparison of the two groups was compared with the analysis of the variance of multiple mean numbers, and the difference was statistically significant in P0.05.
Results: 40 children in the routine treatment group, the fast duration of respiratory frequency was (44.29 + 5.17) h, the fast duration of heart rate was (50 + 6.96) H and 40 cases of sodium nitroprusside group were (24.56 + 5.14) H and (32.60 + 4.67) h respectively, and there were significant differences (P0.01) in the two groups respectively (P0.01), suggesting that nebulized sodium nitroprusside could effectively reduce the respiratory rate of children. And heart rate. Another indicator of measurement of liver palpation and swelling duration, 40 cases (40.21 + 7.56) h in the conventional treatment group and 40 cases (44.13 + 8.36) h in the sodium nitroprusside group (44.13 + 8.36) h, there was a significant difference between the two groups (P0.05). The results suggested that the atomization of sodium nitroprusside could also promote the retracting of the large liver. The sodium nitroprusside atomization group had 40 children. The average brachial artery nebulization was (64.35 + 3.08) mmHg before atomization, and 5min was (64.48 + 3.37) mmHg after atomization, and 5min was (64.55 + 3.97) mmHg after atomization. There was no significant difference between the three groups (P0.05), that is, the mean pressure of the body circulatory artery was not significant with the atomization inhalation of sodium nitroprusside. The high duration of CRP values in the routine treatment group was (7.60 + 1.25) days. Sodium prusside atomization group was (7.44 + 1.21) days, there was no significant difference between the two groups (P0.05), suggesting that atomization treatment with sodium nitroprusside did not significantly affect the infection process of pneumonia.
Conclusion:
1 sodium nitroprusside atomization can effectively reduce the respiratory rate of children with CHF.
2 sodium nitroprusside atomization can effectively reduce the heart rate of children with CHF.
3 sodium nitroprusside atomization promotes the enlargement of liver in children with congenital heart disease and pneumonia with heart failure.
4 nitroprusside atomization reduces pulmonary artery pressure without affecting the mean arterial pressure of systemic circulation.
5 sodium nitroprusside atomization has no effect on pneumonia infection in children with congenital heart disease and pneumonia.
Therefore, in the treatment decision of children with congenital heart disease pneumonia and heart failure, the atomization of sodium nitroprusside can be added on the basis of conventional treatment. It has a clear effect on early relieving the symptoms of heart failure in children, and it is easy to operate and has high safety.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.4
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