CAJ | 학술논문

目的：观察磷酸肌酸钠联合卡托普利治疗儿童病毒性心肌炎的临床疗效及对血浆血管紧张素Ⅱ和氧自由基的影响，为临床治疗提供借鉴。方法选择80例符合入组标准的儿童病毒性心肌炎作为研究对象，按随机数字表法分为观察组40例和对照组40例，两组均进行常规方法治疗，包括休息、维生素 C、抗病毒药物和抗菌剂、营养心肌代谢药药物，对照组再给予卡托普利0．5 mg／kg，2次／d，观察组再给予磷酸肌酸钠联合卡托普利治疗，卡托普利同对照组，磷酸肌酸钠0．5～1 g／d，1次／d，两组均以4周为1个疗程，治疗前后采用放射免疫分析法检测血浆血管紧张素Ⅱ浓度，采用超声心动图检查仪检测心功能指标（心脏射血分数EF、心室短轴缩短率 FS、二尖瓣舒张晚期血流速度峰值与心脏舒张功能二尖瓣舒张早期血流速度峰值比值VA ／TE），进行血清丙二醛（MDA）和超氧化物歧化酶（SOD）检测，评价两组患者临床疗效及心电图疗效。结果观察组的临床疗效及心电图疗效为95％、90％，均明显优于对照组的70％、70％，差异均有统计学意义（χ2＝9．367、8．571，均 P ＜0．05）。观察组和对照组治疗后 EF、FS、SOD 较治疗前明显升高（t ＝11．689、8．447、9．524和7．714、7．985、6．166，均P ＜0．01），血浆血管紧张素Ⅱ浓度、VA ／TE、血清 MDA 较治疗前明显降低（t ＝17．572、5．772、9．744和9．228、3．553、3．855，均 P ＜0．05），观察组治疗后 SOD 明显高于对照组（t ＝3．932，P ＜0．05），VA ／TE、MDA、血管紧张素Ⅱ浓度明显低于对照组（t ＝3．446、3．633、10．315，均 P ＜0．05）。结论磷酸肌酸钠联合卡托普利能够协同改善病毒性心肌炎患儿心功能，与其降低血浆血管紧张素Ⅱ浓度及清除自由基有关，显著提高常规疗法的临床疗效及心电图疗效，是治疗儿童病毒性心肌炎的良好方案，值得临床尝试推广。目的：觀察燐痠肌痠鈉聯閤卡託普利治療兒童病毒性心肌炎的臨床療效及對血漿血管緊張素Ⅱ和氧自由基的影響，為臨床治療提供藉鑒。方法選擇80例符閤入組標準的兒童病毒性心肌炎作為研究對象，按隨機數字錶法分為觀察組40例和對照組40例，兩組均進行常規方法治療，包括休息、維生素 C、抗病毒藥物和抗菌劑、營養心肌代謝藥藥物，對照組再給予卡託普利0．5 mg／kg，2次／d，觀察組再給予燐痠肌痠鈉聯閤卡託普利治療，卡託普利同對照組，燐痠肌痠鈉0．5～1 g／d，1次／d，兩組均以4週為1箇療程，治療前後採用放射免疫分析法檢測血漿血管緊張素Ⅱ濃度，採用超聲心動圖檢查儀檢測心功能指標（心髒射血分數EF、心室短軸縮短率 FS、二尖瓣舒張晚期血流速度峰值與心髒舒張功能二尖瓣舒張早期血流速度峰值比值VA ／TE），進行血清丙二醛（MDA）和超氧化物歧化酶（SOD）檢測，評價兩組患者臨床療效及心電圖療效。結果觀察組的臨床療效及心電圖療效為95％、90％，均明顯優于對照組的70％、70％，差異均有統計學意義（χ2＝9．367、8．571，均 P ＜0．05）。觀察組和對照組治療後 EF、FS、SOD 較治療前明顯升高（t ＝11．689、8．447、9．524和7．714、7．985、6．166，均P ＜0．01），血漿血管緊張素Ⅱ濃度、VA ／TE、血清 MDA 較治療前明顯降低（t ＝17．572、5．772、9．744和9．228、3．553、3．855，均 P ＜0．05），觀察組治療後 SOD 明顯高于對照組（t ＝3．932，P ＜0．05），VA ／TE、MDA、血管緊張素Ⅱ濃度明顯低于對照組（t ＝3．446、3．633、10．315，均 P ＜0．05）。結論燐痠肌痠鈉聯閤卡託普利能夠協同改善病毒性心肌炎患兒心功能，與其降低血漿血管緊張素Ⅱ濃度及清除自由基有關，顯著提高常規療法的臨床療效及心電圖療效，是治療兒童病毒性心肌炎的良好方案，值得臨床嘗試推廣。
목적：관찰린산기산납연합잡탁보리치료인동병독성심기염적림상료효급대혈장혈관긴장소Ⅱ화양자유기적영향，위림상치료제공차감。방법선택80례부합입조표준적인동병독성심기염작위연구대상，안수궤수자표법분위관찰조40례화대조조40례，량조균진행상규방법치료，포괄휴식、유생소 C、항병독약물화항균제、영양심기대사약약물，대조조재급여잡탁보리0．5 mg／kg，2차／d，관찰조재급여린산기산납연합잡탁보리치료，잡탁보리동대조조，린산기산납0．5～1 g／d，1차／d，량조균이4주위1개료정，치료전후채용방사면역분석법검측혈장혈관긴장소Ⅱ농도，채용초성심동도검사의검측심공능지표（심장사혈분수EF、심실단축축단솔 FS、이첨판서장만기혈류속도봉치여심장서장공능이첨판서장조기혈류속도봉치비치VA ／TE），진행혈청병이철（MDA）화초양화물기화매（SOD）검측，평개량조환자림상료효급심전도료효。결과관찰조적림상료효급심전도료효위95％、90％，균명현우우대조조적70％、70％，차이균유통계학의의（χ2＝9．367、8．571，균 P ＜0．05）。관찰조화대조조치료후 EF、FS、SOD 교치료전명현승고（t ＝11．689、8．447、9．524화7．714、7．985、6．166，균P ＜0．01），혈장혈관긴장소Ⅱ농도、VA ／TE、혈청 MDA 교치료전명현강저（t ＝17．572、5．772、9．744화9．228、3．553、3．855，균 P ＜0．05），관찰조치료후 SOD 명현고우대조조（t ＝3．932，P ＜0．05），VA ／TE、MDA、혈관긴장소Ⅱ농도명현저우대조조（t ＝3．446、3．633、10．315，균 P ＜0．05）。결론린산기산납연합잡탁보리능구협동개선병독성심기염환인심공능，여기강저혈장혈관긴장소Ⅱ농도급청제자유기유관，현저제고상규요법적림상료효급심전도료효，시치료인동병독성심기염적량호방안，치득림상상시추엄。
Objective To observe the effect and influence on plasma angiotensin Ⅱ and oxygen radicals in the treatment of children with viral myocarditis by phosphate sodium and captopril,provide reference for clinical treat-ment.Methods 80 children with viral myocarditis met the admissions criteria were randomly divided into the obser-vation group(40 cases)and the control group (40 cases),both group were received conventional therapy,which included rest,vitamin C pin,antiviral and antimicrobial agents,nutritional medicine myocardial metabolism of drugs. The control group was given captopril 0.5mg/kg,bid,the observation group was given phosphate sodium and capto-pril,phosphate sodium 0.5 -1g/d,qd,both groups had been treated for 4 weeks for a course.Plasma angiotensin Ⅱwere detected by radioimmunoassay.The EF,FS,VA /TE were detected by echocardiography instrument.The blood were collected for detecing MDA and SOD.The clinical efficacy and electrocardiogram efficacy were evaluated. Results The clinical efficacy and electrocardiogram efficacy of observation group were 95%,90%,the control group were 70%,70%,and the difference was statistically significant(χ2 =9.367,8.571,both P <0.05).The EF,FS,SOD of the observation group and the control group after treatment was significantly higher than those of before treatment (t =11.689,8.447,9.524 and 7.714,7.985,6.166,all P <0.01).The plasma angiotensin Ⅱ,VA /TE,MDA were significantly lower than those of before treatment(t =17.572,5.772,9.744 and 9.228,3.553,3.855,all P <0.05). The SOD of the observation group after treatment was significantly higher than that of the control group(t =3.932, P <0.05),VA /TE,MDA were significantly lower than that of the control group(t =3.446,3.633,10.315,all P <0.05).Conclusion The method containing phosphate sodium and captopril can collaboratively improve heart func-tion,which may be relate to the decrease in plasma angiotensin Ⅱ and scavenging oxygen free radicals.The method can significantly improve the clinical efficacy and ECG efficacy of conventional therapies,is the better treatment for promoting in the treatment of children with viral myocarditis.