目的 探討鹽酸右美托咪定注射液治療小兒重癥肺炎合并心力衰竭的臨床療效。方法 選取2012年11月—2015年2月天津市寧河縣醫(yī)院兒科收治的重癥肺炎合并心力衰竭患兒78例,隨機(jī)分為對(duì)照組(42例)和治療組(36例)。對(duì)照組給予常規(guī)治療,治療組在對(duì)照組治療基礎(chǔ)上靜脈泵入鹽酸右美托咪定注射液1 μg/kg,10 min推注完畢,然后鹽酸右美托咪定注射液再以0.2～0.5 μg/(kg·h)維持泵入,直至心衰糾正。比較兩組治療前后的心衰臨床監(jiān)測(cè)指標(biāo)、心肌損害監(jiān)測(cè)指標(biāo)和小兒危重病例評(píng)分(PCIS)。結(jié)果 治療后,兩組患兒的心率、肌酸激酶同工酶(CK-MB)、肌鈣蛋白I(cTnI)顯著下降,心臟指數(shù)(CI)、左心室射血分?jǐn)?shù)(LVEF)、心臟舒張?jiān)缙谛氖页溆俣茸畲笾?舒張晚期心室充盈速度最大值(E/A)均明顯升高,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);并且治療組這些指標(biāo)的改變程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組患兒的PCIS評(píng)分均明顯升高,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);并且治療組PCIS評(píng)分的改變程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 鹽酸右美托咪定注射液可用于小兒重癥肺炎合并心力衰竭的治療,降低心率,穩(wěn)定血流動(dòng)力學(xué),減輕炎性因子和缺血再灌注損傷對(duì)心肌細(xì)胞的損傷,值得在兒科領(lǐng)域推廣應(yīng)用。

Objective To observe the efficacy of Dexmedetomidine Hydrochloride Injection in treatment of pediatric severe pneumonia with heart failure. Methods Children (78 cases) with severe pneumonia and heart failure in Department of Pediatrics of Tianjin Ninghe Hospital from November 2012 to February 2015 were randomly divided into control group (42 cases) and treatment group (36 cases). Children in the control group were treated with conventional treatment. Children in the treatment group were iv pump administered with Dexmedetomidine Hydrochloride Injection 1 μg/kg during 10 min on the basis of control group, and then given 0.2 — 0.5 μg/(kg·h) through continuous iv pump until heart failure correction. Heart failure, myocardial damage index, and pediatric clinical Illness score (PCIS) in two groups before and after treatment were compared. Results After treatment, heart rate, CK-MB, CTnI, CI, LVEF, and E/A in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant differences between two groups (P < 0.05). After treatment, PCIS in two groups were obviously increased, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Dexmedetomidine Hydrochloride Injection has good clinical efficacy in treatment of pediatric severe pneumonia with heart failure, can significantly decrease heart rate, keep hemodynamics, and reduce the injury of inflammatory factor and ischemia reperfusion injury aginst myocardial cells, which has a certain clinical application value in the field of pediatrics.