益气复脉、滋心养阴方联合卡托普利片治疗小儿手足口病并发病毒性心肌炎临床研究

樊荣，穆亚宁，康淑红，任晓红

宝鸡市妇幼保健院儿童医院，陕西 宝鸡 721000

摘要：目的 评价益气复脉、滋心养阴方联合卡托普利片治疗小儿手足口病（HFMD）并发病毒性心肌炎（VMC）的临床疗效，并探讨其机制。方法 将 80 例 HFMD 并发 VMC患儿随机分为治疗组和对照组各 40

例。2组均予常规低流量吸氧、心功能监测、利巴韦林抗病毒、果糖营养等，严重者予免疫球蛋白、地塞米松

对症治疗。对照组在此基础上予卡托普利片，0.5 mg/（kg•d），每日 3次，口服；治疗组在对照组基础上予益气复脉、滋心养阴方加减，每日1剂，水煎 180 mL，分 6～10次口服。均治疗2周。观察2组治疗前后血清超敏C反应蛋白（hs-CRP）、血清肌酸激酶（CK）、肌酸激酶同工酶MB（CK-MB）及心功能情况，评价心电图疗效和综合疗效。结果 与本组治疗前比较，2组治疗后 hs-CRP、CK、CK-MB 含量均降低（P＜0.05），治疗组治疗后 CK-MB、CK、hs-CRP 低于对照组（P＜0.05）；与本组治疗前比较，2组治疗后左室射血分数（EF）、心室短轴缩短率（FS）升高，二尖瓣舒张早期血流速度峰值与二尖瓣舒张晚期血流速度峰值的比值（A/E）降低，且治疗后2 组 EF、FS、A/E比较差异有统计学意义（P＜0.05）。治疗组心电图总有效率为 92.5%（37/40），对照组为 75.0%（30/40），2 组比较差异有统计学意义（Z＝-2.370，P＝0.018）；综合疗效治疗组总有效率为

92.5%（37/40），对照组为 77.5%（31/40），2 组比较差异有统计学意义（Z＝-2.397，P＝0.017）。结论 益气复脉、滋心养阴方加减联合卡托普利片能改善 HFMD 并发 VMC 患儿临床症状，提高临床疗效，其机制可能与降低血清 hs-CRP、CK、CK-MB 含量及增强心功能有关。关键词：小儿手足口病；病毒性心肌炎；益气复脉、滋心养阴方；超敏Ｃ反应蛋白；肌酸激酶

DOI：10.3969/j.issn.1005-5304.2017.11.005

中图分类号：R272.951.25；R272.954 文献标识码：A 文章编号：1005-5304(2017)11-0017-05

Clinical Study on Yiqi Fumai and Zixin Yangyin Prescription Combined with Captopril for Treatment of Children’s HFMD Complicated with Viral Myocarditis

FAN Rong, MU Ya-ning, KANG Shu-hong, REN Xiao-hong (Baoji Maternal and Child Health Hospital, Baoji 721000, China)

Abstract: Objective To evaluate the clinical efficacy of Yiqi Fumai and Zixin Yangyin Prescription combined with Captopril for the treatment of children’s hand-foot-mouth disease (HFMD) complicated with viral myocarditis (VMC); To explore the mechanism. Methods Totally 80 cases children with HFMD complicated with VMC were selected and randomly divided into two groups, with 40 cases in each group. Both groups were given conventional low flow oxygen, cardiac function monitoring, ribavirin antiviral, and fructose nutrition, and severe cases were given immune globulin and dexamethasone to relieve symptoms. The control group was given Captopril 0.5 mg/(kg•d), three times a day, orally, on the basis of conventional treatment, and the treatment group was given Yiqi Fumai and Zixin Yangyin Prescription on the basis of control group, one dose a day, decoction 180 mL, 6 to 10 times a day, orally. The treatment in both groups lasted for two weeks. Serum hs-CRP, CK, CK-MB and cardiac function change before and after treatment of the two groups were observed. Electrocardiogram curative effect and comprehensive curative effect were evaluated. Results Compared with before treatment, the contents of hs-CRP, CK-MB, and CK in both groups decreased after treatment (P<0.05), and the treatment group was lower than the control group (P<0.05); Compared with before treatment, EF and FS in both groups increased after treatment, and A/E of mitral valve diastolic blood flow velocity peak decreased after treatment, with statistical significance among EF, FS and A/E between the two groups (P<0.05). The total effective rate of electrocardiogram was 92.5% (37/40) in the treatment group and 75.0% (30/40) in the control group, with statistical significance (Z=-2.370, P=0.018). The total effective rate of