摘要目的 探讨酚妥拉明联合多巴胺微量泵维持与半饱和量毛花苷丙治疗婴幼儿支气管肺炎合并心衰的可行性.方法 66例婴幼儿支气管肺炎合并心衰的患儿随机分为两组,其中酚妥拉明联合多巴胺微量泵维持与半饱和量毛花苷丙组(治疗组)32例,单用全饱和量毛花苷丙组(对照组)34例.两组均给予抗感染等基础治疗措施.治疗组在基础治疗基础上给予:①酚妥拉明剂量2.5 ～5.0μg/(kg·min)联合多巴胺5.0 μg/( kg·min),持续微量泵维持；②毛花苷丙半饱和量20 μg/kg.对照组在基础治疗基础上给予毛花苷丙饱和量40 μg/kg.两组患儿心衰控制后停用毛花苷丙及多巴胺、酚妥拉明.观察患儿心衰的症状、体征及实验室指标改善情况、有无药物不良反应发生,并进行住院日比较.结果 ①治疗后6h、12 h、24 h及48 h观察,治疗组患儿心率明显低于对照组,差异有统计学意义(P ＜0.01)；治疗组患儿呼吸急促、肝脏肿大消失时间及住院日明显短于对照组,差异有统计学意义(P＜0.01).②治疗组心肌肌钙蛋白Ⅰ下降速度比对照组快,差异有统计学意义(P＜0.01).③治疗组未发生与酚妥拉明、多巴胺、毛花苷丙相关的药物不良反应；治疗组洋地黄不良反应发生率低于对照组,差异有统计学意义(P＜0.05).结论 酚妥拉明联合多巴胺微量泵维持与半饱和量毛花苷丙联用治疗婴幼儿支气管肺炎并心力衰竭有相互协同治疗作用,可减少或避免洋地黄中毒的发生,提高安全用药系数.

abstractsObjective To investigate the feasibility of phentolamine and dopamine injected continuously by microinfusion pump combined with 1/2-digitalization lanatoside C on infant bronchopneumonia with heart failure.Methods Sixty-six cases of infant bronchopneumonia with heart failure were randomly divided into two groups,of which 32 cases in the group accepted phentolamine and dopamine injected continuously by microinfusion pump mixed with 1/2-digitalization lanatoside C ( the treatment group) and 34 cases in the group accepted digitalization lanatoside C (the control group).Two groups were given basic treatment such as anti-infection measures.Besides the basic treatment,the following treatments were adopted for the treatment group:① Phentolamine 2.5 ～ 5.0 μg/( kg.min) combined with dopamine 5.0 μg/( kg.min) injected continuousely by microinfusion pump for maintaining treatment; ②1/2-Digitalization lanatoside C 20 μg/kg.Besides the basic treatment,the control group were given the digitalization lanatoside C 40 μg/kg. Lanatoside C and dopamine and phentolamine were stopped after heart failure was controlled.To observe the changes of the symptoms,signs of heart failure and laboratory indicators,and observe whether there were adverse drug reactions or not,to compare the duration of hospitalization between the two groups.Results ①6 h,12 h,24 h and 48 h after treatment,heart rate in the treatment group was significantly lower than the control group and the difference was also statistically significant ( P ＜ 0.01 ).The disappearance time of fast breathing,hepatomegaly,hospitalization in the treatment group was shorter than the control group and the difference was statistically significant (P ＜ 0.01 ).②Cardiac troponin I fell faster in the treatment group than that in the control group and the difference was statistically significant ( P ＜ 0.01 ).③There were no related adverse drug reactions in the treatment group with dopamine,phentolamine,lanatoside C.Incidence of digitalis adverse reactions in the treatment group was lower than the control group and the difference was statistically significant (P ＜ 0.05 ).Conclusions Their coordination,phentolamine and dopamine injected continuously by microinfusion pump combined with 1/2-digitalization lanatoside C on infant bronchopneumonia with heart failure,has mutual effectiveness,which can also reduce or avoid the occurrence of digitalis poisoning and improve drug safety factor.