广州医科大学学报

目的:探讨美托洛尔对肠道病毒71型(EV71)感染手足口病合并心肺功能障碍的治疗效果。方法:对2010年6～8月广西桂林市人民医院收治的16例EV7I感染手足口病危重症患儿的临床资料进行回顾性分析,探讨于心肺衰竭早期在综合治疗基础上应用美托洛尔对心率、血压、末梢循环及肺水肿的影响。选择既往给予综合治疗的10例EV71感染致手足口病的危重症患儿作为对照。结果:加用美托洛尔治疗的患儿的心率下降时间(2.35±1.66)h、高血压纠正时间(2.28±1.87)h、末梢循环改善时间(0.55±0.32)h及肺水肿/肺出血改善时间(23.29±11.37)h均较对照组的(10.71±3.11)h、(9.56±3.38)h、(1.86±0.41)h、(36.65±15.53)h明显缩短(均P<0.05),发生严重心律失常/心脏骤停例数显著低于对照组(P<0.05)。结论:在心肺衰竭早期应用美托洛尔能协助改善危重症手足口病患儿的心肺功能、有效阻止病情进展、改善预后。

Objective:To explore the efficacy of metoprolol in patients with hand-foot-mouth disease due to enterovirus type 71(EV71) infection complicated with cardiopulmonary failure.Methods:A retrospective analysis was carried out on 16 children with severe hand-foot-and-mouth disease due to EV71 infection from Department of Pediatrics,Guilin People's Hospital between June 2010 and August 2010.Clinical efficacy of metoprolol added to the integrated therapy for controlling heart rate,blood pressure,peripheral circulation and pulmonary edema was investigated in children with early-stage cardiopulmonary failure.Ten historic cases of severe hand-foot-and-mouth disease due to EV71 infection receiving integrated therapy were included as control group.Results:Children with metoprolol add-on therapy presented remarkably shorter time(all P<0.05) to reduction in heart rate[(2.35±1.66) h vs.(10.71±3.11) h],rectification of blood pressure[(2.28±1.87) hvs.(9.56+3.38) h],improved peripheral circulation[(0.55±0.32) hvs.(1.86±0.41) h]and recovery from pulmonary edema or pulmonary hemorrhage[(23.29±11.37) h vs.(36.65±15.53) h]as compared with control group.Additionally,children treated with metoprolol were found to have significantly lower incidence rate(P<0.05) of cardiac arrhythmia or arrest.Conclusion:Metoprolol is associated with effective suppression of disease progression and improved prognosis in critically-ill children with hand-foot-and-mouth disease due to EV71 infection complicated with early-stage cardiopulmonary failure by improving the cardiopulmonary function.