米力农联合低分子肝素治疗小儿脓毒血症的临床研究

目的探讨米力农联合低分子肝素治疗小儿脓毒血症的临床疗效。方法选取2015年2月—2017年2月在成都市妇女儿童中心医院进行治疗的脓毒血症患儿210例,随机分为对照组(105例)和治疗组(105例)。对照组皮下注射低分子量肝素钠注射液,5~10 U/次,1次/8~12 h。治疗组在对照组的基础上静脉注射米力农注射液,25~75μg/kg加入20 mL 5%葡萄糖溶液,5~10 min缓慢注射,维持0.5~0.75μg/(kg·h)。两组均进行1周的治疗。评价治疗后两组患者临床疗效,同时比较治疗前后两组APACHEⅡ评分和血清学指标变化。结果治疗后,对照组的总有效率为57.14%,显著低于治疗组的77.14%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患儿APACHEⅡ评分均显著降低(P0.05);且治疗组APACHEⅡ评分明显低于对照组(P0.05)。治疗后,两组患儿降钙素(PCT)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和内皮素-1(ET-1)水平均显著降低,一氧化氮(NO)水平则明显升高,同组比较差异具有统计学意义(P0.05);且治疗组患儿的血清学指标水平显著优于对照组,两组比较差异具有统计学意义(P0.05)。结论米力农注射液联合低分子肝素钠治疗小儿脓毒血症可有效改善机体炎症反应、血管内皮功能和凝血功能,具有一定的临床推广应用价值。

Clinical study on milrinone combined with low molecular heparin in treatment of pediatric sepsis

Objective To investigate the clinical efficacy of milrinone combined with low molecular heparin in treatment of pediatric sepsis. Methods Children (210 cases) with sepsis in Chengdu Women & Children's Center Hospital from February 2015 to February 2017 were randomly divided into control (105 cases) and treatment (105 cases) groups. Children in the control group were subcutaneous injection administered with Low Molecular Weight Heparin Sodium Injection, 5 — 10 U/time, once every 8 — 12 h. Children in the treatment group were iv administered with Milrinone Injection on the basis of the control group, 25—75 μg/kg added into 5% glucose solution 20 mL, and injected with a slow speed for 5 — 10 min, then maintained the speed at 0.5 — 0.75 μg/(kg·h). Children in two groups were treated for 1 week. After treatment, clinical efficacy was evaluated, and APACHEⅡ score and serum indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 57.14%, which was significantly lower than 77.14% in the treatment group, and there were differences between two groups (P <0.05). After treatment, APACHEⅡ scores in two groups were significantly decreased (P < 0.05). And the APACHEⅡ score in the treatment group was significantly lower than that in the control group (P < 0.05). After treatment, the PCT, IL-1β, TNF-α, and ET-1 levels in two groups were significantly decreased, but NO level were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And the serological indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Milrinone combined with low molecular heparin in treatment of pediatric sepsis can effectively improve inflammation reaction, vascular endothelial and coagulation function, which has a certain clinical application value.