Cardiac failure in children with pneumonia in Papua New Guinea
Cardiac failure in children with pneumonia in Papua New Guinea
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DOI：
10.1097/00006454-199812000-00008
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发表时间：
1998-12-01
影响因子：
3.6
通讯作者：
Coakley, J
中科院分区：
文献类型：
--
作者：
Shann, F;Macgregor, D;Coakley, J
背景心力衰竭被怀疑是导致发展中国家儿童肺炎死亡的原因，但其作用尚未明确定义。方法。对巴布亚新几内亚戈罗卡医院收治的47名儿童的便利样本进行了前瞻性研究，包括超声、胸部X光片以及肌酸激酶和乳酸脱氢酶测定。47名儿童中有7名（15%）死亡。在43名接受胸片检查的儿童中，31名（72%）患有重度或极重度肺炎。超声检查没有发现心脏收缩力差或心肌同工酶明显升高的患儿，因此没有发现败血症导致心肌损伤的证据，但超声检查显示12例（26%）患儿右心室或肝静脉扩张（7例均扩张），4例（33%）死亡;这表明26%的患者存在继发于肺动脉高压的右心室心力衰竭。（95%置信区间，14 - 40%）。心动过速与超声右心室扩张无关，但4例腹部可触及肝脏超过3 cm的患儿中有3例右心室扩张。12例右心衰竭患儿中仅4例有肝肿大、心动过速、颈静脉压升高或外周水肿。右心室衰竭在重症肺炎患儿中很常见，可能是由肺动脉高压而不是脓毒性毒血症引起的，心力衰竭的临床体征不可靠。没有证据表明地高辛是继发于肺动脉高压的右心室衰竭的有效治疗方法。
Background. Cardiac failure is suspected of contributing to mortality from pneumonia in children in developing countries, but its role has not been clearly defined.Methods. A convenience sample of 47 children admitted to Goroka Hospital in Papua New Guinea was studied prospectively with ultrasound, chest radiographs and assays of creatine kinase and lactate dehydrogenase.Results. Seven (15%) of the 47 children died. Of the 43 children who had a chest radiograph, 31 (72%) had severe or very severe pneumonia. No child had poor contractility of the heart on ultrasound examination or unequivocally raised cardiac isoenzymes; therefore no evidence of myocardial injury from sepsis was found. However, ultrasound examination showed dilatation of the right ventricle or hepatic veins in 12 (26%) of the children (both were dilated in 7 children) and 4 (33%) of these children died; this suggests that right ventricular cardiac failure secondary to pulmonary hypertension was present in 26% (95% confidence interval, 14 to 40%) of these children with severe pneumonia. Tachycardia was not associated with right ventricular dilatation on ultrasound, but 3 of the 4 children with more than 3 cm of liver palpable in the abdomen had right ventricular dilatation. Only 4 of the 12 children with right heart failure had hepatomegaly, tachycardia, raised jugular venous pressure or peripheral edema.Conclusions. Right ventricular failure is common in children with severe pneumonia, and it is probably caused by pulmonary hypertension rather than septic toxemia, The clinical signs of heart failure are unreliable. There is no evidence that digoxin is effective treatment for right ventricular failure secondary to pulmonary hypertension.