目的:探讨多巴酚丁胺联合美罗培南对先天性心脏病合并心衰肺炎患儿血清脑钠肽(BNP)、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及超敏C-反应蛋白(hs-CRP)的影响.方法:选择我院收治的70例先天性心脏病合并心衰肺炎患儿,随机分为对照组和治疗组各35例.对照组单纯给予多巴酚丁胺治疗,治疗组给予多巴酚丁胺联合美罗培南治疗,两组连续给予治疗10 d.检测并比较两组治疗前后血清BNP、IGF-1、IGFBP-3、TNF-α、IL-6及hs-CRP水平.结果:两组血清BNP、IGF-1、IGFBP-3、TNF-α、IL-6及hs-CRP的治疗前水平比较,差异均无统计学意义(P>0.05);两组血清BNP、TNF-α、IL-6及hs-CRP的治疗后水平均明显低于治疗前,血清IGF-1、IGFBP-3的治疗后水平均明显高于治疗前,并且治疗组血清BNP、TNF-α、IL-6及hs-CRP水平下降明显大于对照组,血清IGF-1、IGFBP-3水平升高明显大于对照组,差异均具有统计学意义(P<0.05).结论:多巴酚丁胺联合美罗培南治疗先天性心脏病合并心衰肺炎患儿的临床疗效显著,能够明显降低血清BNP、TNF-α、IL-6及hs-CRP水平,升高血清IGF-1、IGFBP-3水平,值得在临床上推广应用.%Objective: To study the effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia.Methods A total of 70 children with congenital heart disease and pneumonia in our hospital from June 2014 to October 2016 were enrolled in this study.The subjects were divided into the control group (n=35) and the treatment group (n=35) randomly.The control group were treated with dobutamine, the treatment group were treated with dobutamine combined with meropenem.The two groups were treated for 10 days.The serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before and after treatment were compared.Results There were no significantly differences of the serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before treatment (P>0.05).The serum BNP, TNF-a, IL-6 and hs-CRP levels of the two groups after treatment were significantly lower than before treatment (P<0.05), the serum IGF-1 and IGFBP-3levels of the two groups after treatment were significantly higher than before treatment (P<0.05), and that of the treatment group were significantly better than the control group (P<0.05).Conclusions Dobutamine combined with meropenem can significantly reduce the serum BNP, TNF-a, IL-6 and hs-CRP levels, improve serum IGF-1 and IGFBP-3 levels of children with congenital heart disease and pneumonia, and it was worthy clinical application.
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