【摘要】：目的探討左卡尼汀對手足口病(HFMD)伴心肌酶異常的影響。方法收集2013年5月-2016年6月診治的660例伴心肌酶異常的HFMD患兒,隨機分為A組(果糖二磷酸鈉治療組,220例)、B組(左卡尼汀治療組,220例)、C組(左卡尼汀聯(lián)合果糖二磷酸鈉治療組,220例),3組患兒均予常規(guī)基礎(chǔ)治療。分別在治療前和治療后7 d,檢測血AST、LDH、CK、CK-MB、c Tn I水平的變化,同時觀察每日心率變化、治療前后心電圖變化以及重癥轉(zhuǎn)化率等指標,并進行統(tǒng)計分析。結(jié)果治療前,3組患兒性別、年齡、病程、病情嚴重程度等指標比較差異無統(tǒng)計學(xué)意義;治療后,B組和C組患兒痊愈率,顯著高于A組(均P0.05);B組和C組患兒重癥轉(zhuǎn)化率、心電圖恢復(fù)率均顯著低于A組(均P0.05);心率恢復(fù)正常時間,B組和C組均較A組明顯縮短(均P0.05);而B組和C組兩組比較,在臨床痊愈率、重癥轉(zhuǎn)化率、心電圖恢復(fù)率、心率恢復(fù)正常時間等方面,均差異無統(tǒng)計學(xué)意義(均P0.05);治療后心肌酶譜指標AST、LDH、CK、CK-MB、c Tn I恢復(fù)率比較,B組、C組均顯著高于A組(均P0.05);心肌酶譜指標平均水平B組和C組患兒均較A組降低(均P0.05);而B組和C組治療后心肌酶恢復(fù)正常率、心肌酶譜指標平均水平,均差異無統(tǒng)計學(xué)意義(均P0.05)。結(jié)論腸道病毒感染后HFMD并心肌酶異常的患兒,給以左卡尼汀等輔助營養(yǎng)心肌治療可顯著改善心肌酶譜指標及心電圖的異常,同時降低危重癥轉(zhuǎn)化率及改善預(yù)后。
[Abstract]:Objective to investigate the effect of levacarnitine on myocardial enzyme abnormalities in patients with hand, foot and mouth disease (HFMD). Methods from May 2013 to June 2016, 660 HFMD patients with abnormal myocardial enzymes were randomly divided into two groups: group A (treated with fructose diphosphate) and group), B (220 cases treated with leucarnitine). Group C (group C, 220 cases) were treated with L-carnitine and sodium fructose diphosphate. All the children in group C were treated with routine basic therapy. Blood AST,LDH,CK,CK-MB,c Tn I levels were measured before and 7 days after treatment. Daily heart rate changes, electrocardiogram changes and severe transformation rate were observed and analyzed statistically. Results before treatment, there was no significant difference in sex, age, course of disease and severity of illness among the three groups, the recovery rate of group B and group C was significantly higher than that of group A (P0.05). The severe conversion rate and ECG recovery rate of group B and group C were significantly lower than those of group A (P0.05), the time of heart rate returning to normal was significantly shorter in group B and group C than that in group A (P0.05). There was no significant difference between group B and group C in clinical recovery rate, severe conversion rate, ECG recovery rate, heart rate recovery time and so on (P0.05). The recovery rate of myocardial enzyme index AST,LDH,CK,CK-MB,c Tn I in group B and group C was significantly higher than that in group A (P0.05), and the average level of myocardial enzymes in group B and group C was lower than that in group A (P0.05). However, there was no significant difference between group B and group C in the recovery rate of myocardial enzymes and the average level of myocardial enzymes after treatment (P0.05). Conclusion in children with HFMD complicated with abnormal myocardial enzymes after enterovirus infection, the myocardial enzymes and electrocardiogram (ECG) abnormalities can be significantly improved by the treatment of L-carnitine and other supplementary nutritional myocardial treatments, and the transformation rate of critical cases is reduced and the prognosis is improved.
【作者單位】： 鄭州兒童醫(yī)院重癥監(jiān)護室;鄭州市兒童急危重癥醫(yī)學(xué)重點實驗室;
【基金】：常州四藥臨床藥學(xué)科研基金項目(編號:CZSYJJ16033)
【分類號】：R725.1

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