小儿重症肺炎的心功能分析

1、小儿重症肺炎的心功能分析    小儿重症肺炎的心功能分析 The Analysis of Heart Function of Severe Pneumonia in Children【中文摘要】 目的:通过观察肺炎患儿的心肌酶CK-MB值、心脏超声的EF值、E/A比值、肺动脉压,以及比较去乙酰毛花苷与美托洛尔治疗小儿肺炎合并心衰的临床效果,探讨小儿重症肺炎对心脏功能的影响。方法:以2008年1月至12月期间,我院儿科确诊为肺炎的住院患儿为对象。在年龄小于1岁的患儿中,随机抽取40名患儿做为研究对象,根据是否合并心力衰竭,分为两组,即心衰组(heart f

2、ailure,HF组,n=20)和非心衰组(non -heart failure,non-HF组,n=20),再将心衰组的20名患儿随机分为两组,即去乙酰毛花苷组(n=10)和美托洛尔组(n=10)。40名肺炎患儿中,男孩为23例,占57.5%,女孩为17例,占42.5%,心衰组中,男孩为12例,占60%,女孩为8例,占40%,非心衰组中,男孩为11例,占55%,女孩为9例,占45%,去乙酰毛花苷组与美托洛尔组中,男孩各6例,女孩各4例,男女比例为3:2。肺炎的诊断标准为:(1)症状:发热、咳嗽、呼吸短促。(2)体征:肺部可闻及固定的中、细湿啰音?)辅助检查:胸部X线片显示有炎性渗出。小儿肺炎

3、合并心力衰竭的诊断标准为:(1)呼吸突然加快,>60次/分。(2)心率突然>180次/分。(3)骤发极度烦躁不安,明显发绀,面色发灰,指(趾)甲微血管充盈时间延长。(4)心音低钝,奔马律,颈静脉怒张。(5)肝脏迅速增大。(6)尿少或无尿,颜面眼睑或双下肢水肿。具有前5项者即可诊断为心力衰竭。对于有原发性心脏疾病(如:先天性心脏病、心律失常、心源性休克、感染性心内膜炎、心肌炎、心肌病、心包炎等)的患儿,不列入本研究对象。所有患儿均于入院后第二天清晨空腹抽取静脉血2ml,送我院生化室,由生化分析仪测定心肌酶,记录CK-MB值。并于安静状态下,于我院心脏超声室查心脏超声,均由同一医务人员

4、操作,记录EF值、E/A值、肺动脉压力。心衰组的患儿均用心电监护仪实时监测心率。记录去乙酰毛花苷组与美托洛尔组心衰纠正所需的天数。所有记录的数据用SPSS16.0统计软件进行统计学处理,并进行方差齐性及正态性的检验,结果用均数±标准差( x±s)表示,两组间均数的比较采用t检验,p<0.05为差异有显著性。结果:1心肌酶CK-MB的变化非心衰组的心肌酶CK-MB为13.90±6.79U/L,心衰组的心肌酶CK-MB为19.07±7.19U/L,两组均数比较有显著差异性(p<0.05)。即心衰组患儿的CK-MB显著高于非心衰组。2射血分数(EF

5、)的变化非心衰组的EF值为67.96±5.76(%),心衰组的EF值为68.81±5.77(%),两组均数比较无显著差异性(p>0.05)。即心衰组的EF值与非心衰组比较无显著差异。3 E/A比值的变化非心衰组的E/A比值为1.53±0.35,心衰组的E/A比值为1.42±0.30,两组均数比较无显著差异性(p>0.05)。心衰组的E/A比值与非心衰组比较无显著差异。4去乙酰毛花苷与美托洛尔治疗效果的比较去乙酰毛花苷组纠正心衰的时间为4.80±2.04天,美托洛尔组纠正心衰的时间为4.50±1.72天。两组均数比较无显著差

6、异性(p>0.05)。即美托洛尔组纠正心衰的时间与去乙酰毛花苷组比较无显著差异。5肺动脉高压的情况非心衰组与心衰组均未发现有肺动脉高压。结论:1.小儿轻症肺炎仅累及呼吸系统本身,重症肺炎可使心肌细胞受损,引起心肌酶CK-MB升高。2.小儿重症肺炎虽可引起心肌损伤,但并不影响心脏的泵血功能。3.与去乙酰毛花苷相比,美托洛尔同样可以改善小儿肺炎合并心力衰竭的临床表现。【英文摘要】 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