普罗帕酮与美托洛尔对小儿川崎病合并心律失常的疗效研究
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摘要
目的探讨普罗帕酮(Pro)与美托洛尔(Met)治疗川崎病(KD)合并心律失常的临床效果及其对患儿血浆超敏C-反应蛋白(hs-CRP)、脑钠肽(BNP)水平的影响。方法选取我院2013年6月至2017年6月收治的106例KD合并心律失常患儿,按照随机数字表法平均分为2组。对照组给予Met治疗;观察组予以Pro治疗。记录并比较两组患儿的临床疗效,心功能指标,血浆hs-CRP、BNP水平,以及用药安全性。结果治疗1周后,观察组的总有效率为94.3%,明显高于对照组的77.4%(P<0.05);观察组的CI值、LVEF值均显著高于对照组[(3.87±0.32)L/(min·m~2) vs.(3.59±0.35)L/(min·m~2),74.9%±4.1%vs. 71.2%±5.3%,P<0.01],LVED值显著低于对照组[(3.02±0.17)cm vs.(3.39±0.24)cm,P<0.01];观察组血浆hs-CRP、BNP水平均显著低于对照组[(6.4±1.5)mg/L vs.(12.5±2.8)mg/L,(115.3±14.8)pg/ml vs.(172.6±21.4)pg/ml,P<0.01]。观察组不良反应发生率为5.7%,对照组为7.5%,两组比较差异无统计学意义(P>0.05)。结论普罗帕酮、美托洛尔在KD合并心律失常的治疗中,其安全性方面优势相当,但普罗帕酮的抗心律失常作用更强,能更有效保护患儿心肌细胞,改善患儿心功能。
Objective To explore the clinical effect of propafenone(Pro) and metoprolol(Met) on arrhythmia in children with Kawasaki disease(KD),as well as its impact on the levels of high sensitivity C-reactive protein(hs-CRP) and brain natriuretic peptide(BNP).Methods Totally 106 children with KD complicated with arrhythmia in our hospital from June 2013 to June 2017 were selected and were randomly divided into two groups.Control group was treated with Met,while observation group was treated with Pro.The clinical efficacy,cardiac function,plasma hs-CRP and BNP levels,and drug safety were recorded and compared between the two groups.Results After 1 week of treatment,the overall effective rate of observation group was 94.3%,which was significantly higher than 77.4% of control group(P<0.05);the CI and LVEF value of observation group were significantly higher than those of control group [(3.87±0.32)L/(min·m~2) vs.(3.59±0.35)L/(min·m~2),74.9%±4.1% vs.71.2%±5.3%,P<0.01],while the LVED value was significantly lower in observation group than that in control group [(3.02±0.17)cm vs.(3.39±0.24)cm,P<0.01];the plasma levels of hs-CRP and BNP in observation group were significantly lower than those in control group [(6.4±1.5)mg/L vs.(12.5±2.8)mg/L,(115.3±14.8)pg/ml vs.(172.6±21.4)pg/ml,P<0.01].The rates of adverse drug reaction in observation group and control group were 5.7% and 7.5%,and there was no significant difference between the two groups(P>0.05).Conclusion Metoprolol and propafenone have comparable advantages in safety in the treatment of KD with arrhythmia,but propafenone has stronger antiarrhythmic effect,which can effectively protect cardiac myocytes and improve cardiac function in children.
Objective To explore the clinical effect of propafenone(Pro) and metoprolol(Met) on arrhythmia in children with Kawasaki disease(KD),as well as its impact on the levels of high sensitivity C-reactive protein(hs-CRP) and brain natriuretic peptide(BNP).Methods Totally 106 children with KD complicated with arrhythmia in our hospital from June 2013 to June 2017 were selected and were randomly divided into two groups.Control group was treated with Met,while observation group was treated with Pro.The clinical efficacy,cardiac function,plasma hs-CRP and BNP levels,and drug safety were recorded and compared between the two groups.Results After 1 week of treatment,the overall effective rate of observation group was 94.3%,which was significantly higher than 77.4% of control group(P<0.05);the CI and LVEF value of observation group were significantly higher than those of control group [(3.87±0.32)L/(min·m~2) vs.(3.59±0.35)L/(min·m~2),74.9%±4.1% vs.71.2%±5.3%,P<0.01],while the LVED value was significantly lower in observation group than that in control group [(3.02±0.17)cm vs.(3.39±0.24)cm,P<0.01];the plasma levels of hs-CRP and BNP in observation group were significantly lower than those in control group [(6.4±1.5)mg/L vs.(12.5±2.8)mg/L,(115.3±14.8)pg/ml vs.(172.6±21.4)pg/ml,P<0.01].The rates of adverse drug reaction in observation group and control group were 5.7% and 7.5%,and there was no significant difference between the two groups(P>0.05).Conclusion Metoprolol and propafenone have comparable advantages in safety in the treatment of KD with arrhythmia,but propafenone has stronger antiarrhythmic effect,which can effectively protect cardiac myocytes and improve cardiac function in children.
引文
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[3] 梁妍琰,张晓梅,朱华.不同年龄谱的川崎病患儿90例临床特征研究[J].中国小儿急救医学,2017,24(3):235-238.
[4] 刘璐,柳茵.联合检测hs CRP、BNP、甲状腺激素辅助诊断心肌梗死的意义[J].中西医结合心脑血管病杂志,2016,14(7):720-722.
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[8] 胡静,钱炜,李红,等.川崎病急性期中性粒细胞功能的活化及与冠脉脉损伤的关系[J].实用医学杂志,2017,33(19):3328-3329.
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[10] 王策,于宪一.320例川崎病患儿临床特点及冠状动脉损伤的高危因素分析[J].中国小儿急救医学,2018,25(12):939-942,947.
[11] 韩磊森.琥珀酸美托洛尔治疗射血分数保留的心力衰竭患者的有效性评估[J].中国医药,2018,13(4):492-495.
[12] 卢周舟,徐琢,王婧,等.琥珀酸美托洛尔缓释片治疗心房颤动疗效及对胃饥饿素表达影响[J].临床军医杂志,2018,46(12):1452-1453.
[13] 吴志刚.美托洛尔联合稳心颗粒治疗心房颤动的临床效果[J].中国医药,2018,13(11):1612-1615.
[14] 李博宁,刘琮,刘麟,等.小儿房性心动过速药物治疗分析[J].儿科药学杂志,2015,21(8):11-14.
[15] 张晓丹,余更生.美托洛尔治疗心律失常的现状及进展[J].儿科药学杂志,2015,21(1):59-62.
[16] 谢志才,贠国俊,刘建中.普罗帕酮治疗小儿川崎病合并心律失常的疗效及安全性[J].中国妇幼保健,2013,28(8):1286-1288.
[17] 马力忠,莫庆仪,梁桂明,等.小儿阵发性室上性心动过速102例临床复律方法分析[J].儿科药学杂志,2015,21(6):24-27.
[18] 杨红.酒石酸美托洛尔联合普罗帕酮治疗女性更年期心律失常的有效性及安全性研究[J].实用心脑肺血管病杂志,2015,23(3):13-15.
[19] 田静,安新江,徐亮,等.CRP和NTproBNP对小儿川崎病的临床意义[J].中西医结合心脑血管病杂志,2016,14(20):2426-2428.
[20] 王秀丽,秦淑红,冯骄,等.探讨C反应蛋白与血小板参数在川崎病患儿中的应用价值[J].中国临床实用医学,2018,9(6):43-45.
[21] 罗厚龙,刘行超,谭秋培,等.急性冠状动脉综合征患者CysC、hs-CRP及Mb水平及相关性研究[J].检验医学与临床,2016,13(9):1156-1157,1160.
[22] 黄坤美,吴永忠,赖伟权,等.川崎病患儿急性期血浆脑利钠肽、D-二聚体、纤维蛋白原水平变化与临床观察[J].实用医学杂志,2015,31(12):2001-2003.
[23] 张清云,周芸玲,唐杰,等.慢性心力衰竭合并房颤患者血浆BNP水平的变化[J].中国循证心血管医学杂志,2016,8(7):878-880.
[2] Holve TJ,Patel A,Chau Q,et al.Long-term cardiovascular outcomes in survivors of Kawasaki disease[J].Pediatrics,2014,133(2):e305-e311.
[3] 梁妍琰,张晓梅,朱华.不同年龄谱的川崎病患儿90例临床特征研究[J].中国小儿急救医学,2017,24(3):235-238.
[4] 刘璐,柳茵.联合检测hs CRP、BNP、甲状腺激素辅助诊断心肌梗死的意义[J].中西医结合心脑血管病杂志,2016,14(7):720-722.
[5] Ayusawa M,Sonobe T,Uemura S,et al.Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition)[J].Pediatr Int,2005,47(2):232-234.
[6] 伏忠阳,易婧,郭明.胺碘酮与普罗帕酮治疗心律失常的疗效对比分析[J].昆明医科大学学报,2015,36(3):153-154.
[7] 凌楠,安新江,牛玲.普罗帕酮治疗小儿川崎病合并心律失常的疗效及安全性分析[J].中国妇幼健康研究,2016,27(5):611-613.
[8] 胡静,钱炜,李红,等.川崎病急性期中性粒细胞功能的活化及与冠脉脉损伤的关系[J].实用医学杂志,2017,33(19):3328-3329.
[9] Rodó X,Curcoll R,Robinson M,et al.Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan[J].Proc Natl Acad Sci U S A,2014,111(22):7952-7957.
[10] 王策,于宪一.320例川崎病患儿临床特点及冠状动脉损伤的高危因素分析[J].中国小儿急救医学,2018,25(12):939-942,947.
[11] 韩磊森.琥珀酸美托洛尔治疗射血分数保留的心力衰竭患者的有效性评估[J].中国医药,2018,13(4):492-495.
[12] 卢周舟,徐琢,王婧,等.琥珀酸美托洛尔缓释片治疗心房颤动疗效及对胃饥饿素表达影响[J].临床军医杂志,2018,46(12):1452-1453.
[13] 吴志刚.美托洛尔联合稳心颗粒治疗心房颤动的临床效果[J].中国医药,2018,13(11):1612-1615.
[14] 李博宁,刘琮,刘麟,等.小儿房性心动过速药物治疗分析[J].儿科药学杂志,2015,21(8):11-14.
[15] 张晓丹,余更生.美托洛尔治疗心律失常的现状及进展[J].儿科药学杂志,2015,21(1):59-62.
[16] 谢志才,贠国俊,刘建中.普罗帕酮治疗小儿川崎病合并心律失常的疗效及安全性[J].中国妇幼保健,2013,28(8):1286-1288.
[17] 马力忠,莫庆仪,梁桂明,等.小儿阵发性室上性心动过速102例临床复律方法分析[J].儿科药学杂志,2015,21(6):24-27.
[18] 杨红.酒石酸美托洛尔联合普罗帕酮治疗女性更年期心律失常的有效性及安全性研究[J].实用心脑肺血管病杂志,2015,23(3):13-15.
[19] 田静,安新江,徐亮,等.CRP和NTproBNP对小儿川崎病的临床意义[J].中西医结合心脑血管病杂志,2016,14(20):2426-2428.
[20] 王秀丽,秦淑红,冯骄,等.探讨C反应蛋白与血小板参数在川崎病患儿中的应用价值[J].中国临床实用医学,2018,9(6):43-45.
[21] 罗厚龙,刘行超,谭秋培,等.急性冠状动脉综合征患者CysC、hs-CRP及Mb水平及相关性研究[J].检验医学与临床,2016,13(9):1156-1157,1160.
[22] 黄坤美,吴永忠,赖伟权,等.川崎病患儿急性期血浆脑利钠肽、D-二聚体、纤维蛋白原水平变化与临床观察[J].实用医学杂志,2015,31(12):2001-2003.
[23] 张清云,周芸玲,唐杰,等.慢性心力衰竭合并房颤患者血浆BNP水平的变化[J].中国循证心血管医学杂志,2016,8(7):878-880.