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目的:观察硫酸镁治疗重症手足口病早期(神经系统受累期)患儿的效果及儿茶酚胺等指标的变化,为针对早期重症手足口病患儿儿茶酚胺水平的干预治疗提供参考。方法:选取2013年7月至2015年5月于我院住院治疗的重症手足口病患儿(血糖≥7.8 mmol/L)82例,随机分为对照组40例和观察组42例。对照组给予利巴韦林抗病毒、地塞米松抗炎、甘露醇降颅压,维持水电解质平衡、补充能量,必要时加用呋塞米利尿、肌苷营养心肌等常规治疗;观察组在常规治疗基础上,静脉滴注25%硫酸镁50~60 mg/(kg·d)。两组疗程均为5~7 d。分别于治疗前、治疗72 h后采集静脉血检测白细胞(WBC)、血糖(BG)、肌酸激酶同工酶(CK-MB)、神经元特异性烯醇化酶(NSE)及去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)水平,记录两组患儿神经系统受累持续时间及住院时间,评价疗效。结果:两组患儿均治愈。治疗72 h后,观察组DA、NSE、BG、WBC、CK-MB水平均降低,对照组仅NSE水平降低,且观察组NE、DA、NSE水平低于对照组(P均<0.05)。观察组神经系统受累时间短于对照组(P<0.05)。结论:在常规治疗基础上加用静脉滴注硫酸镁,能降低早期重症手足口病患儿儿茶酚胺水平,减少激素副作用,减少或防止患儿病情进一步恶化。
Objective: To observe the effects of magnesium sulfate on children with severe HFMD in the early stage (nervous system involvement) and the changes of catecholamines in order to provide a reference for interventional therapy of catecholamine in children with severe HFMD. Methods: From July 2013 to May 2015, 82 children with severe HFMD who were hospitalized in our hospital (blood glucose ≥7.8 mmol / L) were randomly divided into control group (n = 40) and observation group (n = 42). Control group was given ribavirin antiviral, anti-inflammatory dexamethasone, mannitol reduce intracranial pressure, maintain water and electrolyte balance, add energy, if necessary, add furosemide diuretic, inosine nutritional myocardium and other conventional treatment; observation group in the Based on routine treatment, intravenous infusion of 25% magnesium sulfate 50 ~ 60 mg / (kg · d). The two courses of treatment were 5 ~ 7 d. Venous blood was collected to measure WBC, BG, CK-MB, NSE and norepinephrine before treatment and 72 h after treatment respectively. (NE), epinephrine (E), and dopamine (DA) were measured. The duration of neurological involvement and hospital stay were recorded in both groups to evaluate the efficacy. Results: Two groups of children were cured. The levels of DA, NSE, BG, WBC and CK-MB in the observation group decreased after 72 hours of treatment, while only the levels of NSE in the control group decreased. The levels of NE, DA and NSE in the observation group were lower than those in the control group (all P <0.05). The neurological involvement time in the observation group was shorter than that in the control group (P <0.05). Conclusion: The addition of magnesium sulfate intravenously on the basis of routine treatment can reduce the levels of catecholamines, reduce the side effects of hormones and reduce or prevent the further deterioration of children’s disease in children with severe HFMD.