无创心输出量监测联合米力农在小儿重症肺炎并心力衰竭中的疗效对比观察及对脑钠肽水平的影响研究

目的: 观察无创心输出量监测（USCOM）联合米力农在小儿重症肺炎并心力衰竭中的临床效果及对脑钠肽水平的影响。方法: 将78例重症肺炎并心力衰竭患儿随机分为实验组和对照组，每组各39例。对照组接受吸氧、抗感染、抗心衰及维持离子酸碱平衡治疗，予以多巴胺5 μg·kg^-1·min^-1静脉滴注，维持24 h；观察组在对照组基础上给予米力农0.5 μg·kg^-1·min^-1，静脉滴注，维持24 h。两组患儿均接受5 d治疗，比较两组患儿临床症状、体征改善率、心功能指标、炎症因子、脑钠肽水平，以及药物不良反应的发生情况。结果: 治疗后，观察组烦躁消失、湿罗音消失、肝脏回缩及面色转红润改善率，均高于对照组（P<0.05）；观察组哺乳时间缩短率，低于对照组（P<0.05）；治疗后，观察组心率（HR）水平，低于对照组（P<0.05）；观察组主动脉峰流速（Vpk）、射血时间及校正后射血时间（FTc）、每搏输出量指数（SVI）水平均高于对照组（P<0.05）；治疗后，观察组肿瘤坏死因子α（TNF-α）、白介素（IL）-6、IL-8、IL-10及脑钠肽水平，均低于对照组（P<0.05）；治疗后，观察组与对照组恶心呕吐、腹泻、血压波动、肝肾功能异常发生率差异无统计学意义（P>0.05）。结论: 米力农用于小儿重症肺炎并心力衰竭患者中能获得较高的近期疗效，能缩短临床症状、体征消失，降低炎症因子及药物不良反应发生率，治疗过程中给予USCOM监测能反映患者心功能水平，有助于指导临床治疗，值得推广应用。

Comparison of the efficacy of non-invasive USCOM and milrinone in children with severe pneumonia and heart failure and its effect on brain natriuretic peptide levels

AIM: To observe the clinical effect of non-invasive cardiac output monitoring (USCOM) combined with milrinone in children with severe pneumonia and heart failure and the effect on brain natriuretic peptide levels. METHODS: Seventy-eight children with severe pneumonia and heart failure were randomly divided into experimental group and control group, with 39 cases in each group. The control group received oxygen, anti-infection, anti-heart failure and maintenance of ionic acid-base balance treatment, and was given intravenous infusion of dopamine 5 μg·kg^-1·min^-1 for 24 h. The observation group was given milrinone 0.5 μg·kg^-1·min^-1 based on the control group, intravenous drip, maintained for 24 h. Both groups received 5 d treatment, and the clinical symptoms, signs improvement rate, cardiac function index, inflammatory factors, brain natriuretic peptide levels, and adverse drug reactions were compared between the two groups. RESULTS: After treatment, the irritability disappeared, the wet rales disappeared, the liver retraction and the ruddy rosy improvement rate were higher in the observation group than in the control group (P<0.05). The shortening rate of breast-feeding time in the observation group was lower than that in the control group (P<0.05). After treatment, the HR level in the observation group was lower than that in the control group (P<0.05); the Vpk, FTc and SVI levels in the observation group were higher than those in the observation group. After treatment, the levels of TNF-α, IL-6, IL-8, IL-10 and brain natriuretic peptide in the observation group were lower than those in the control group (P<0.05); No significant difference of nausea and vomiting, diarrhea, blood pressure fluctuation and liver and kidney dysfunction (P>0.05) was observed between the two groups. CONCLUSION: Milrinone can achieve higher short-term curative effect in patients with severe pneumonia and heart failure, which can shorten the clinical symptoms and signs, reduce the incidence of inflammatory factors and adverse drug reactions, and give USCOM monitoring during the treatment to reflect the heart function of patients. Levels help to guide clinical treatment and are worth promoting.