左西孟旦联合中药制剂治疗严重脓毒症心肌损伤患者的临床效果
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摘要
目的研究分析左西孟旦联合中药对严重脓毒症心肌损伤患者血清乳酸(Lac)、可溶性CD14亚型(Presepsin)和诱导型一氧化氮合酶(iNOS)指标水平的影响以及对心脏的保护作用。方法选择2011年6月-2015年6月本院急诊科及ICU病房收治的严重脓毒症合并心肌损伤患者100例作为研究对象,入组患者均符合严重脓毒症及心肌损伤的相关诊断标准,随机数表法将患者分为研究组51例及对照组49例,除基础治疗外给予对照组患者左西孟旦注射液治疗,研究组患者在此基础上联合应用中药制剂柴胡人参汤,观察比较两组患者治疗效果及对心脏功能的保护情况。结果研究组患者治疗疗效率优于对照组(Z=2.511,P=0.012);两组患者治疗后APACHEⅡ评分、中医证候积分(11.02±2.30vs 13.49±3.15)、(7.54±1.23vs 10.88±3.10)比较差异有统计学意义(P<0.05);两组患者治疗前Lac、Presepsin和NOS水平比较差异无统计学意义,治疗后指标均有所降低,且研究组患者改善效果优于对照组(P<0.05);两组患者治疗前心功能指标左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)及左心室舒张末期内径(LVEDD)水平比较差异无统计学意义,经相应治疗后均有所改善,且研究组患者改善效果更佳(P<0.05)。结论左西孟旦联合中医药治疗严重脓毒症合并心肌损伤能有效抗感染、抑制炎症反应,减轻心肌的损伤作用,对心功能保护效果佳,值得临床推广使用。
OBJECTIVE To observe the impact of levosimendan combined with traditional Chinese medicine on serum lactate(Lac),soluble CD14 subtype(Presepsin)and inducible nitric oxide synthase(iNOS)of the severe sepsis patients complicated with myocardial injury and the effect on protection of heart.METHODS A total of 100 severe sepsis patients complicated with myocardial injury who were treated in emergency department and ICU from Jun 2011 to Jun 2015 were recruited as the study objects,all of the enrolled patients were eligible for the diagnostic criteria of severe sepsis and myocardial injury,the patients were randomly divided into the study group with 51 cases and the control group with 49 cases.Besides the primary treatment,the control group was treated with levosimendan injection,while the study group was given additional Chinese traditional medicine Bupleurum Chineng Decoction.The curative effects and protective effects on cardiac function were observed and compared between the two groups of patients.RESULTS The effective rate of treatment of the study group was significantly higher than that of the control group(Z=2.511,P=0.012).There were significant differences in APACHE Ⅱ score and TCM syndrome score(11.02±2.30 vs 13.49±3.15),(7.54±1.23 vs 10.88±3.10)between the two groups of patients after the treatment(P<0.05).There were no significant differences in the levels of Lac,Presepsin and NOS between the two groups of patients before the treatment,the levels of the above indexes were significantly reduced after the treatment,and the above indexes of the study group were improved better than those of the control group(P<0.05).There were no significant differences in the cardiac function indexes left ventricular ejection fraction(LVEF),left ventricular end-systolic dimension(LVESD)and left ventricular end-diastolic dimension(LVEDD)between the two groups of patients before the treatment,the cardiac function indexes were improved after the treatment and were improved better in the study group than in the control group(P <0.05).CONCLUSIONLevosimendan combined with traditional Chinses medicine can effectively treat infection,inhibit inflammatory reactions,alleviate the myocardial injury and achieve remarkable protective effect on cardiac function,and it is worthy to be promoted in the hospital.
OBJECTIVE To observe the impact of levosimendan combined with traditional Chinese medicine on serum lactate(Lac),soluble CD14 subtype(Presepsin)and inducible nitric oxide synthase(iNOS)of the severe sepsis patients complicated with myocardial injury and the effect on protection of heart.METHODS A total of 100 severe sepsis patients complicated with myocardial injury who were treated in emergency department and ICU from Jun 2011 to Jun 2015 were recruited as the study objects,all of the enrolled patients were eligible for the diagnostic criteria of severe sepsis and myocardial injury,the patients were randomly divided into the study group with 51 cases and the control group with 49 cases.Besides the primary treatment,the control group was treated with levosimendan injection,while the study group was given additional Chinese traditional medicine Bupleurum Chineng Decoction.The curative effects and protective effects on cardiac function were observed and compared between the two groups of patients.RESULTS The effective rate of treatment of the study group was significantly higher than that of the control group(Z=2.511,P=0.012).There were significant differences in APACHE Ⅱ score and TCM syndrome score(11.02±2.30 vs 13.49±3.15),(7.54±1.23 vs 10.88±3.10)between the two groups of patients after the treatment(P<0.05).There were no significant differences in the levels of Lac,Presepsin and NOS between the two groups of patients before the treatment,the levels of the above indexes were significantly reduced after the treatment,and the above indexes of the study group were improved better than those of the control group(P<0.05).There were no significant differences in the cardiac function indexes left ventricular ejection fraction(LVEF),left ventricular end-systolic dimension(LVESD)and left ventricular end-diastolic dimension(LVEDD)between the two groups of patients before the treatment,the cardiac function indexes were improved after the treatment and were improved better in the study group than in the control group(P <0.05).CONCLUSIONLevosimendan combined with traditional Chinses medicine can effectively treat infection,inhibit inflammatory reactions,alleviate the myocardial injury and achieve remarkable protective effect on cardiac function,and it is worthy to be promoted in the hospital.
引文
[1]周小洋,许兆军,刘鹏,等.左西孟旦对严重脓毒症/脓毒性休克患者病死率影响的Meta分析[J].中华危重症医学杂志(电子版),2017,10(4):252-257.
[2]问军锋,马岚.左西孟旦治疗脓毒性休克患者临床效果观察及对血流动力学水平的影响[J].河北医药,2017,39(10):1468-1470.
[3]王若晖,李卉,梁群.46例脓毒症患者的中西医结合治疗效果观察[J].世界中医药,2017,12(4):761-764.
[4] Pisano A,Monti G,Landoni G.Levosimendan:new indications and evidence for reduction in perioperative mortality[J].Curr Opin Anaesthesiol,2016,29(4):454-461.
[5]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[6]梁茂新,赵磊,慕杨娜,等.中药新药证候疗效评价的客观性和科学性质疑[J].中华中医药杂志,2015(11):3815-3817.
[7]赵国桢,郭玉红,李博,等.中医药防治脓毒症的研究进展[J].中国中药杂志,2017,42(8):1423-1429.
[8]赵雷,钱风华,沈梦雯,等.柴胡人参汤治疗脓毒症心肌损伤患者的临床疗效评价[J].上海中医药大学学报,2016,30(6):19-24.
[9] Malaska J,Slezak M,Muriova K,et al.Myocardial dysfunction in sepsis-diagnostics and therapy[J].Vnitr Lek,2010,56(3):226-232.
[10]葛旭,谢苗荣,王国兴.乌司他丁联合大黄对脓毒症心肌损伤的保护作用[J].临床和实验医学杂志,2016,15(16):1601-1604.
[11] Salinas JL,Rentsch C,Marconi VC,et al.Baseline,time-updated,and cumulative HIV care metrics for predicting acute myocardial infarction and all-cause mortality[J].Clin Infect Dis,2016,63(11):1423-1430.
[12]刘敏,罗苑苑,林新锋.中西医结合治疗脓毒症心肌损伤的研究进展[J].广州中医药大学学报,2015,32(4):778-780.
[13]黄河,孙小聪,麦晓勤,等.左西孟旦治疗脓毒症休克并心肌抑制的临床疗效观察[J].四川医学,2015,36(6):831-834.
[14] Yousif NG,Hadi NR,Hassan AM.Indocyanine green-001(ICG-001)attenuates Wnt/β-catenin-induces myocardial injury following sepsis[J].J Pharmacol Pharmacother,2017,8(1):14-20.
[15]韩娟,周大勇,武慧,等.中医药干预对脓毒症患者预后相关指标的影响[J].中国中医急症,2014,23(11):2006-2008.
[2]问军锋,马岚.左西孟旦治疗脓毒性休克患者临床效果观察及对血流动力学水平的影响[J].河北医药,2017,39(10):1468-1470.
[3]王若晖,李卉,梁群.46例脓毒症患者的中西医结合治疗效果观察[J].世界中医药,2017,12(4):761-764.
[4] Pisano A,Monti G,Landoni G.Levosimendan:new indications and evidence for reduction in perioperative mortality[J].Curr Opin Anaesthesiol,2016,29(4):454-461.
[5]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[6]梁茂新,赵磊,慕杨娜,等.中药新药证候疗效评价的客观性和科学性质疑[J].中华中医药杂志,2015(11):3815-3817.
[7]赵国桢,郭玉红,李博,等.中医药防治脓毒症的研究进展[J].中国中药杂志,2017,42(8):1423-1429.
[8]赵雷,钱风华,沈梦雯,等.柴胡人参汤治疗脓毒症心肌损伤患者的临床疗效评价[J].上海中医药大学学报,2016,30(6):19-24.
[9] Malaska J,Slezak M,Muriova K,et al.Myocardial dysfunction in sepsis-diagnostics and therapy[J].Vnitr Lek,2010,56(3):226-232.
[10]葛旭,谢苗荣,王国兴.乌司他丁联合大黄对脓毒症心肌损伤的保护作用[J].临床和实验医学杂志,2016,15(16):1601-1604.
[11] Salinas JL,Rentsch C,Marconi VC,et al.Baseline,time-updated,and cumulative HIV care metrics for predicting acute myocardial infarction and all-cause mortality[J].Clin Infect Dis,2016,63(11):1423-1430.
[12]刘敏,罗苑苑,林新锋.中西医结合治疗脓毒症心肌损伤的研究进展[J].广州中医药大学学报,2015,32(4):778-780.
[13]黄河,孙小聪,麦晓勤,等.左西孟旦治疗脓毒症休克并心肌抑制的临床疗效观察[J].四川医学,2015,36(6):831-834.
[14] Yousif NG,Hadi NR,Hassan AM.Indocyanine green-001(ICG-001)attenuates Wnt/β-catenin-induces myocardial injury following sepsis[J].J Pharmacol Pharmacother,2017,8(1):14-20.
[15]韩娟,周大勇,武慧,等.中医药干预对脓毒症患者预后相关指标的影响[J].中国中医急症,2014,23(11):2006-2008.