目的 探討采用血必凈注射液聯(lián)合多巴酚丁胺和甲磺酸酚妥拉明治療重癥肺炎合并心力衰竭患兒的臨床效果和安全性。方法 選取2016年1月—2017年2月許昌市中心醫(yī)院收治的重癥肺炎合并心力衰竭患兒86例，隨機分為對照組和治療組，每組各43例。對照組靜脈滴注2.5 μg/（kg∙min）的鹽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，連續(xù)滴注3 h，1次/d。治療組在對照組基礎(chǔ)上靜脈滴注血必凈注射液，0.5 mL/kg加入5%葡萄糖溶液中，1次/d。兩組患兒均治療5 d。觀察兩組患兒臨床療效，比較治療前后兩組患兒住院時間和癥狀改善情況及動脈血氣指標、炎性因子和心功能相關(guān)指標。結(jié)果 治療后，對照組的臨床有效率為88.10%，顯著低于治療組的97.67%，兩組比較差異具有統(tǒng)計學意義（P < 0.05）。治療后，治療組住院時間和癥狀改善時間均顯著短于對照組患兒（P < 0.05）。治療后，兩組動脈血氧飽和度（SaO₂）、氧合指數(shù)（pO₂/FiO₂）、動脈血氧分壓（pO₂）均明顯升高（P < 0.05）；且治療組動脈血氣指標水平明顯高于對照組（P < 0.05）。治療后，兩組患兒白介素-6（IL-6）、C反應蛋白（CRP）、IL-8和腫瘤壞死因子-α（TNF-α）水平均顯著降低（P < 0.05）；且治療組這些炎性因子水平明顯低于對照組（P < 0.05）。治療后，兩組患兒左室短軸縮短率（LVFS）和左室射血分數(shù)LVEF水平明顯升高，血清腦鈉素（BNP）和心肌肌鈣蛋白（cTnI）水平顯著降低，同組比較差異具有統(tǒng)計學意義（P < 0.05）；且治療組患兒心功能相關(guān)指標水平明顯優(yōu)于對照組（P < 0.05）。結(jié)論 血必凈注射液聯(lián)合多巴酚丁胺和甲磺酸酚妥拉明治療重癥肺炎合并心力衰竭患兒效果顯著，能明顯改善患兒癥狀體征、動脈血氣、心功能和機體炎癥狀態(tài)。

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.

河南省醫(yī)學科技攻關(guān)計劃項目（201503057）