| Objective:Heart Failure is a common urgent in children,especially in infants. Severe pneumonia and Congenital heart disease combine with Severe pneumonia are a common reason that happen acute heart failure in infants. Heart failure is a clinical syndrome that because of the heart function decline,although the heart can play decompensation, still can’t pump enough oxygenation to meet the metabolic needs of the body tissue, and it may develop to cardiogenic shock endanger the patient’s life if there is no timely diagnose and reasonable treatment. This articles is to compare the difference in two treatment protocols(Cediland and Milrinone), which are to control heart failure by analysising and observing the respiration,heart rate, liver size and BNP level in60patients with Severe pneumonia combine with Heart failure.Methods:The samples were collected from60patients with Severe pneumonia combined with Heart failure which came from pediatric ward between2010.10to2011.12in our hospital,and observed by their respiration, heart rate, liver size and BNP level. It included36boys and24girls; the smallest age was2months, the biggest age was8months. According to the different treatments, we divided them into2groups by random, which were Cediland group(n=30) and Milrinone group(n=30).The Cediland treatment was add cediland on the basis of routine anti heart failure(oxygen inhalation,sedation,anti infection), and the specific usage was gave0.03mg/kg to the patients younger than2years.First digitalizated:the first time gave the half of total then divided the allowance into twice and were given by every6hours.12hours later,began to give maintenance dose, which was1/4of the total and was given by every day until the heart failure was controlled. The Milrinone treatment was add Milrinone on the basis of routine anti heart failure(oxygen inhalation,sedation,anti infection),and the specific usage was gave loading dose50ug/kg every5minutes by injecting slowly, then gave0.5ug/kg every minute to keep12hours until the heart failure was controlledThe diagnostic code of Heart Failure:《The Seventh Edition of Pediatrics》 and with the exception of the congenital heart disease, cardiac arrhythmias, dilated cardiomyopathy caused by heart failure. All of the patients were not given cardiotonic and collected the information in20minutes after hospitalization, also recorded their respiratory frequency, heart rate,liver size, urine volume and BNP level. After that observed the patient every3hours and record information, took the daily average value as the observation results until the heart failure was controlled(the standard:the respiratory frequency≤59times/min the heart rate≤159times/min, the liver size<3cm, the urine volume>200ml). If the patient’s BNP>100pg/ml record at hospitalization, we can recheck it in the very next day and fourth day. At the same time took the20healthy children blood BNP as control group.The date were analyzed by spss13.0. First normal distribution test, the result was p<0.1, was skewed distribution and expressed by median. The difference between two groups was analyzed by multiple independent sampler nonparameter test, the value of p<0.05was regarded as statistical significance.Results:1the effect of respiratory frequency between cediland treatment group and milrinone treatment group on children with severe pneumonia combined with heart failureBoth the median for respiratory frequency improvement time in Milrinone treatment group and the median in Cediland was2days. Compared with two groups, the value of p>0.05was not regarded as statistical significance, Milrinone in treatment of severe pneumonia combined with heart failure in children with respiratory frequency improvement was not better than Cediland treatment group.2the effect of heart rate between cediland treatment group and milrinone treatment group on children with severe pneumonia combined with heart failureBoth the median for heart rate improvement time in Milrinone treatment group the median in Cediland and the median in Cediland was2days. Compared with two groups, the value of p>0.05was not regarded as statistical significance, Milrinone in treatment of severe pneumonia combined with heart failure in children with heart rate improvement was not better than Cediland treatment group3the effect of liver retraction between cediland treatment group and milrinone treatment group on children with severe pneumonia combined with heart failureThe median for liver retraction in two groups were2days.Compared with two groups, the value of p>0.05was not regarded as statistical significance, Milrinone in treatment of severe pneumonia combined with heart failure in children with liver retraction improvement was not better than Cediland treatment group4the effect of urine volume between cediland treatment group and milrinone treatment group on children with severe pneumonia combined with heart failureThe median for urine volume return to normal in two groups were1day.Compared with two groups, the value of p>0.05was not regarded as statistical significance, Milrinone in treatment of severe pneumonia combined with heart failure in children with urine volume improvement was not better than Cediland treatment group5the relationship of BNP between the clinlical diagnosis of heart failure in children and healthy infantsThe median BNP in Milrinone treatment group was6.050pg/ml, the median in Cediland treatment group was6.200pg/ml, the median in healthy infants was6.550pg/ml.Compared with two groups, the value of p>0.05was not regarded as statistical significance, the BNP in clinical diagnosis of heart failure was not higher than healthy infants.Conclusion: 1.Milrinone treatment group in treatment of severe pneumonia combined with heart failure in children in improving respiratory frequency,heart rate,liver retraction,urine volume was not better than Cediland treatment group.2.the BNP in clinical diagnosis of severe pneumonia combined with heart failure is not high,so we can’t take BNP level as the gold standard in diagnosing severe pneumonia combined with heart failure in clinical. |
PDF Full Text Request