目的 探讨采用血必净注射液联合多巴酚丁胺和甲磺酸酚妥拉明治疗重症肺炎合并心力衰竭患儿的临床效果和安全性。方法 选取2016年1月—2017年2月许昌市中心医院收治的重症肺炎合并心力衰竭患儿86例，随机分为对照组和治疗组，每组各43例。对照组静脉滴注2.5 μg/（kg∙min）的盐酸多巴酚丁胺注射液和1~1.5 μg/（kg∙min）的甲磺酸酚妥拉明注射液，二者加入5%葡萄糖溶液25 mL，连续滴注3 h，1次/d。治疗组在对照组基础上静脉滴注血必净注射液，0.5 mL/kg加入5%葡萄糖溶液中，1次/d。两组患儿均治疗5 d。观察两组患儿临床疗效，比较治疗前后两组患儿住院时间和症状改善情况及动脉血气指标、炎性因子和心功能相关指标。结果 治疗后，对照组的临床有效率为88.10%，显著低于治疗组的97.67%，两组比较差异具有统计学意义（P < 0.05）。治疗后，治疗组住院时间和症状改善时间均显著短于对照组患儿（P < 0.05）。治疗后，两组动脉血氧饱和度（SaO₂）、氧合指数（pO₂/FiO₂）、动脉血氧分压（pO₂）均明显升高（P < 0.05）；且治疗组动脉血气指标水平明显高于对照组（P < 0.05）。治疗后，两组患儿白介素-6（IL-6）、C反应蛋白（CRP）、IL-8和肿瘤坏死因子-α（TNF-α）水平均显著降低（P < 0.05）；且治疗组这些炎性因子水平明显低于对照组（P < 0.05）。治疗后，两组患儿左室短轴缩短率（LVFS）和左室射血分数LVEF水平明显升高，血清脑钠素（BNP）和心肌肌钙蛋白（cTnI）水平显著降低，同组比较差异具有统计学意义（P < 0.05）；且治疗组患儿心功能相关指标水平明显优于对照组（P < 0.05）。结论 血必净注射液联合多巴酚丁胺和甲磺酸酚妥拉明治疗重症肺炎合并心力衰竭患儿效果显著，能明显改善患儿症状体征、动脉血气、心功能和机体炎症状态。

Objective To investigate the clinical efficacy and safety of Xuebijing Injection combined with dobutamine and phentolamine in treatment of severe pneumonia with heart failure. Methods Children (86 cases) with severe pneumonia with heart failure in Xuchang Central Hospital from January 2016 to February 2017 were randomly divided into control and treatment groups, and each group had 43 cases. Children in the control group were iv administered with Dobutamine Hydrochloride Injection 2.5 μg/(kg∙min) and Phentolamine Mesilate Injection 1 — 1.5 μg/(kg∙min), the drugs added into 5% glucose solution 25 mL and continuous intravenous drip for 3 h, once daily. Children in the treatment group were iv administered with Xuebijing Injection on the basis of the control group, 0.5 mL/kg in 5% glucose solution, once daily. Children in two groups were treated for 5 d. After treatment, the clinical efficacy was evaluated, and the hospitalization time and symptom improvement time, arterial blood gas indexes, inflammatory factors, cardiac function related indicators in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 88.1%, which was significantly lower than 97.67% in the treatment group, and there were differences between two groups (P < 0.05). After treatment, the hospitalization time and symptom improvement time in the treatment group was significantly shorter than that in the control group, with significant difference between two groups (P < 0.05). After treatment, the SaO₂, pO₂/FiO₂ and pO₂ in two groups were significantly increased (P < 0.05), and the arterial blood gas indexes in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the IL-6, CRP, IL-8 and TNF-α levels in two groups were significantly decreased (P < 0.05), and the inflammatory factors levels in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the LVFS and LVEF levels in two groups were significantly increased, but the BNP and cTnI levels were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the cardiac function related indicators levels in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Xuebijing Injection combined with dobutamine and phentolamine has significant effect in treatment of severe pneumonia with heart failure effective with heart failure, can significantly improve the symptoms and signs, the arterial blood gas, cardiac function and the inflammatory state.

河南省医学科技攻关计划项目（201503057）