磷酸肌酸钠联合利巴韦林治疗小儿病毒性心肌炎的临床疗效及其对患儿心肌酶水平的影响

摘要

Objective:To investigate the clinical efficacy of creatine phosphate sodium combined with ribavirin in the treatment of infantile viral myocarditis,and to elucidate its mechanism of the effects on myocardial enzyme levels in the children.Methods:A total of 96 children with viral myocarditis were selected;according to the random number grouping method,they were divided into observation group and control group (n=48).The myocardial enzymes and cardiac troponin Ⅰ (cTnI) of the patients in two groups were detected,and anti-infection,supplementation of electrolytes,and nutritional support for myocardial treatment were performed;then intravenous infusion therapy of ribavirin was used.On this basis,the patients in observation group were given intravenous infusion of creatine phosphate sodium for 14 d.After treatment,the total effective rate of treatment of the patients in two groups,the levels of myocardial enzymes and cTnI and electrocardiogram were compared before and after treatment.Results:The total effective rate of the patients in observation group was 87.50％ (42/48),and it was 70.83％ (34/48) in control group;there was significant difference (x2 =4.04,P=0.04).After treatment,the levels of lactate dehydrogenase (LDH),hydroxybutyrate dehydrogenase (HBDH),aspartate transaminase (AST),creatine phosphokinase (CPK),creatine kinase isoenzyme-MB (CK-MB) and CTnI of the patients in two groups after treatment were lower than before treatment (P＜0.05).The indicators mentioned above of patients in observation group were lower than those in control group (P ＜0.05).The total improvement rate of electrocardiogram in the observation group (89.58％) was significantly higher than that in control group (72.92 ％),and the difference was statistically significant (x2 =4.38,P =0.04).Conclusion:The total effective rate of creatine phosphate sodium combined with ribavirin in the treatment of infantile viral myocarditis is higher,and they can significantly reduce the levels of myocardial enzymes and improve the cardiac function;it is worth to apply in the clinical treatment.%目的:探讨磷酸肌酸钠联合利巴韦林治疗病毒性心肌炎患儿临床疗效,并阐述其对患儿心肌酶水平的影响.方法:选取病毒性心肌炎患儿96例,按照随机数字表法分为观察组和对照组,每组48例.2组患儿就诊后均行心肌酶谱和肌钙蛋白Ⅰ (cTnI)等检测,同时行抗感染、补充电解质及营养心肌等支持治疗,并均给予利巴韦林静脉滴注治疗.在此基础上,观察组患者给予磷酸肌酸钠静滴,疗程均为14 d.治疗后比较2组患儿治疗总有效率和治疗前后心肌酶及cTnI水平和心电图改善情况.结果:观察组患儿治疗总有效率为87.50％(42/48),对照组患儿治疗总有效率为70.83％ (34/48),组间比较差异有统计学意义(x2=4.04,P=0.04);2组患儿治疗后乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、天冬氨酸氨基转移酶(AST)、肌酸磷酸激酶(CPK)、肌酸磷酸激酶同工酶(CK-MB)和cTnI水平均明显低于治疗前(P＜0.05),且观察组患儿上述指标水平均明显低于对照组(P＜0.05);观察组患儿心电图改善总有效率(89.58％)高于对照组(72.92％),组间比较差异有统计学意义(x2 =4.38,P=0.04).结论:磷酸肌酸钠联合利巴韦林治疗病毒性心肌炎患儿总有效率更高,且能明显降低患儿心肌酶水平,改善心功能,值得临床推广.