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目的观察山莨菪碱治疗儿童急性高原病(acute high altitude disease,AHAD)的效果和安全性。方法 AHAD患儿54例,其中急性轻症高原病(acute mild altitude disease,AMAD)患儿23例,高原肺水肿(high altitude pulmonary edema,HAPE)患儿31例,将AMAD患儿随机分为AMAD治疗组12例和AMAD对照组11例,将HAPE患儿随机分为HAPE治疗组16例和HAPE对照组15例。AMAD对照组给予卧床休息,高流量持续吸氧,并给予维生素C0.5g+三磷酸腺苷10~20 mg+辅酶A 50~100u+质量分数10%葡萄糖注射液50~100 mL,静脉滴注,1次/d;AMAD治疗组在AMAD对照组治疗基础上给予山莨菪碱0.1~0.2mg/kg静脉注射,间隔30min重复给药,连用3次;HAPE对照组在AMAD对照组治疗基础上给予呋塞米1mg/kg,静脉注射,每6~8h重复1次;地塞米松0.2mg/kg,静脉注射,每12~24h重复1次;HAPE治疗组在HAPE对照组治疗基础上给予山莨菪碱0.1~0.2mg/kg静脉注射,间隔30min重复给药,连用3次。比较AMAD对照组与治疗组头痛、呕吐、心悸胸闷、呼吸困难、腹胀、腹泻持续时间,比较HAPE对照组与治疗组咳嗽、咳痰症状改善时间、呼吸困难症状改善时间、肺部细湿啰音消失时间、X线胸片肺部阴影消失时间。结果 AMAD治疗组头痛持续时间(35.2±3.8)h、呕吐持续时间(18.5±2.1)h、心悸胸闷持续时间(29.4±3.1)h、呼吸困难持续时间(15.5±1.4)h、腹胀腹泻持续时间(25.4±2.9)h)均少于AMAD对照组((41.6±4.2)、(21.4±2.2)、(32.5±3.3)、(17.3±1.5)、(28.6±2.8)h)(P<0.05);HAPE治疗组咳嗽、咳痰症状改善时间(35.6±3.8)h、呼吸困难症状改善时间(27.5±2.9)h、肺部啰音消失时间(6.9±1.5)h、X线胸片肺部阴影消失时间(39.3±3.6)h)均少于HAPE对照组((42.8±4.1)、(30.4±3.2)、(13.4±1.7)、(43.6±3.9)h)(P<0.05)。结论AMAD和HAPE患儿在常规治疗基础上应用山莨菪碱可缩短症状持续时间。
Objective To observe the efficacy and safety of anisodamine in the treatment of acute high altitude disease (AHAD) in children. Methods Fifty-four AHAD children were enrolled. Among them, 23 were acute mild altitude disease (AMAD) and 31 were high altitude pulmonary edema (HAPE). AMAD children were randomly divided into AMAD Twelve patients in the treatment group and 11 patients in the AMAD control group were randomly divided into HAPE treatment group (n = 16) and HAPE control group (n = 15). AMAD control group were given bed rest, high-flow continuous oxygen, and given vitamin C0.5g + adenosine triphosphate 10 ~ 20 mg + coenzyme A 50 ~ 100u + mass fraction of 10% glucose injection 50 ~ 100 mL, intravenous infusion, The AMAD treatment group was given anisodamine 0.1 ~ 0.2mg / kg intravenously on the basis of the AMAD control group, repeated administration 30min intervals for 3 times; HAPE control group was given furosemide 1mg / kg on the basis of AMAD control group , Repeated every 6 ~ 8h once; dexamethasone 0.2mg / kg, repeated once every 12 ~ 24h; HAPE treatment group was treated with anisodamine 0.1 ~ 0.2mg / kg intravenously, repeated administration interval 30min, once every 3 times. The duration of improvement of cough and expectoration of the HAPE control group and the treatment group was compared between the AMAP control group and the treatment group with headache, vomiting, chest tightness, dyspnea, bloating, and diarrhea duration. The time for improvement of dyspnea symptoms, Disappear time, X-ray chest shadow disappear time. Results Duration of headache (35.2 ± 3.8) h, duration of vomiting (18.5 ± 2.1) h, duration of palpitation chest tightness (29.4 ± 3.1) h, duration of dyspnea (15.5 ± 1.4) h, duration of abdominal distension and diarrhea (25.4 ± 2.9) h were lower than AMAD control group (41.6 ± 4.2), (21.4 ± 2.2), (32.5 ± 3.3), (17.3 ± 1.5) and (28.6 ± 2.8) h respectively ; HAPE treatment group cough, sputum symptom improvement time (35.6 ± 3.8) h, dyspnea symptom improvement time (27.5 ± 2.9) h, pulmonary rales disappearance time (6.9 ± 1.5) h, X-ray chest shadow Disappearance time (39.3 ± 3.6) h) were lower than those in HAPE control group (42.8 ± 4.1), (30.4 ± 3.2), (13.4 ± 1.7) and (43.6 ± 3.9) h respectively. Conclusion Anisodamine can shorten the duration of symptoms in AMAD and HAPE children on the basis of routine treatment.