目的 探討米力農(nóng)聯(lián)合低分子肝素治療小兒膿毒血癥的臨床療效。方法 選取2015年2月—2017年2月在成都市婦女兒童中心醫(yī)院進(jìn)行治療的膿毒血癥患兒210例，隨機(jī)分為對(duì)照組（105例）和治療組（105例）。對(duì)照組皮下注射低分子量肝素鈉注射液，5～10 U/次，1次/8～12 h。治療組在對(duì)照組的基礎(chǔ)上靜脈注射米力農(nóng)注射液，25～75 μg/kg加入20 mL 5%葡萄糖溶液，5～10 min緩慢注射，維持0.5～0.75 μg/（kg·h）。兩組均進(jìn)行1周的治療。評(píng)價(jià)治療后兩組患者臨床療效，同時(shí)比較治療前后兩組APACHEⅡ評(píng)分和血清學(xué)指標(biāo)變化。結(jié)果 治療后，對(duì)照組的總有效率為57.14%，顯著低于治療組的77.14%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）。治療后，兩組患兒APACHEⅡ評(píng)分均顯著降低（P< 0.05）；且治療組APACHEⅡ評(píng)分明顯低于對(duì)照組（P< 0.05）。治療后，兩組患兒降鈣素（PCT）、白細(xì)胞介素-1β（IL-1β）、腫瘤壞死因子-α（TNF-α）和內(nèi)皮素-1（ET-1）水平均顯著降低，一氧化氮（NO）水平則明顯升高，同組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）；且治療組患兒的血清學(xué)指標(biāo)水平顯著優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P< 0.05）。結(jié)論 米力農(nóng)注射液聯(lián)合低分子肝素鈉治療小兒膿毒血癥可有效改善機(jī)體炎癥反應(yīng)、血管內(nèi)皮功能和凝血功能，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical efficacy of milrinone combined with low molecular heparin in treatment of pediatric sepsis. Methods Children (210 cases) with sepsis in Chengdu Women & Children's Center Hospital from February 2015 to February 2017 were randomly divided into control (105 cases) and treatment (105 cases) groups. Children in the control group were subcutaneous injection administered with Low Molecular Weight Heparin Sodium Injection, 5-10 U/time, once every 8-12 h. Children in the treatment group were iv administered with Milrinone Injection on the basis of the control group, 25—75 μg/kg added into 5% glucose solution 20 mL, and injected with a slow speed for 5-10 min, then maintained the speed at 0.5-0.75 μg/(kg·h). Children in two groups were treated for 1 week. After treatment, clinical efficacy was evaluated, and APACHEⅡ score and serum indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 57.14%, which was significantly lower than 77.14% in the treatment group, and there were differences between two groups (P < 0.05). After treatment, APACHEⅡ scores in two groups were significantly decreased (P < 0.05). And the APACHEⅡ score in the treatment group was significantly lower than that in the control group (P < 0.05). After treatment, the PCT, IL-1β, TNF-α, and ET-1 levels in two groups were significantly decreased, but NO level were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And the serological indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Milrinone combined with low molecular heparin in treatment of pediatric sepsis can effectively improve inflammation reaction, vascular endothelial and coagulation function, which has a certain clinical application value.