左西孟旦联合重组人脑利钠肽治疗脓毒症心功能障碍的疗效及其对短期预后的影响
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摘要
目的探讨左西孟旦联合重组人脑利钠肽(rh-BNP)治疗脓毒症心功能障碍的疗效及其对短期预后的影响。方法选取2014年1月—2017年1月四川省医学科学院·四川省人民医院收治的脓毒症心功能障碍患者78例,采用随机数字表法分为对照组和观察组,每组39例。对照组患者在基础治疗基础上给予rh-BNP,观察组患者在基础治疗基础上给予左西孟旦联合rh-BNP。比较两组患者治疗前及治疗后12 h、24 h、72 h、7 d急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分、心率(HR)、平均动脉压、每小时尿量、肌酐(Cr)、N末端脑钠肽前体(NT-proBNP),治疗前及治疗后12 h、24 h、72 h氧合指数、全心射血分数(GEF)、心脏指数(CI)、血管外肺水指数(ELWI),并观察两组患者治疗过程中不良反应发生情况及随访28 d死亡情况。结果 (1)时间与方法在每小时尿量、CI上存在交互作用(P<0.05),而在APACHEⅡ评分、HR、平均动脉压、Cr、NT-proBNP、氧合指数、GEF、ELWI上不存在交互作用(P>0.05);时间在APACHEⅡ评分、HR、每小时尿量、Cr、GEF、CI上主效应显著(P<0.05),而在平均动脉压、NT-proBNP、氧合指数、ELWI上主效应不显著(P>0.05);方法在APACHEⅡ评分、HR、每小时尿量、GEF、CI、ELWI上主效应显著(P<0.05),而在平均动脉压、Cr、NT-proBNP、氧合指数上主效应不显著(P>0.05)。观察组患者治疗后72 h APACHEⅡ评分、HR、ELWI低于对照组,每小时尿量、GEF、CI高于对照组(P<0.05);观察组患者治疗后7 d APACHEⅡ评分低于对照组,每小时尿量高于对照组(P<0.05)。(2)两组患者治疗过程中均未出现严重不良反应。(3)观察组患者随访28 d病死率低于对照组(P<0.05)。结论左西孟旦联合rh-BNP可有效增强脓毒症心功能障碍患者心肌收缩力,改善患者心功能,逐渐增加患者尿量,且安全性较高,有利于改善患者短期预后。
Objective To investigate the curative effect and impact on short-term prognosis of levosimendan combined with recombinant human brain natriuretic peptide(rh-BNP)in treating patients with sepsis-induced cardiac dysfunction. Methods A total of 78 patients with sepsis-induced cardiac dysfunction were selected in Medical Scientific Academy of Sichuan & Sichuan Provincial People's Hospital from January 2014 to January 2017,and they were divided into control group and observation group according to random number table method,each with 39 cases. Patients in control group were given rh-BNP based on basic treatment,while patients in observation group were given levosimendan combined with rhBNP based on basic treatment. APACHE Ⅱ score,heart rate(HR),MAP,urine volume per hour,Cr,NT-proBNP before treatment,12 hours,24 hours,72 hours and 7 days after treatment,oxygenation index,global ejection fraction(GEF),cardiac index and ELWI before treatment,12 hours,24 hours and 72 hours after treatment were compared between the two groups,incidence of adverse reactions during treatment and death status 28 days after follow-up were observed. Results(1)There were statistically significant interaction in urine volume per hour and cardiac index between time and method(P<0.05),but there was no statistically significant interaction in APACHE Ⅱ score,HR,MAP,Cr,NT-proBNP,oxygenation index,GEF or ELWI between time and method(P>0.05);main effect of time was statistically significant in APACHE Ⅱ score,HR,urine volume per hour,Cr,GEF and cardiac index,respectively(P<0.05),but was not statistically significant in MAP,NT-proBNP,oxygenation index or ELWI(P>0.05);main effect of method was statistically significant in APACHE Ⅱscore,HR,urine volume per hour,GEF,cardiac index and ELWI(P<0.05),was not statistically significant in MAP,Cr,NT-proBNP or oxygenation index(P>0.05). After 72 hours of treatment,APACHE Ⅱ score,HR and ELWI in observation group were statistically significantly lower than those in control group,while urine volume per hour,GEF and CI in observation group were statistically significantly higher than those in control group(P<0.05);after 7 days of treatment,APACHE Ⅱ score in observation group was statistically significantly lower than that in control group,while urine volume per hour in observation group was statistically significantly higher than that in control group(P<0.05).(2)No one in the two groups occurred any serious adverse reactions.(3)Fatality rate in observation group was statistically significantly lower than that in control group 28 days after treatment(P<0.05). Conclusion In patients with sepsis-induced cardiac dysfunction,levosimendan combined with rh-BNP can effectively enhance the myocardial contractility,improve the cardiac function,gradually increase the urine volume,with relatively high safety,and is helpful to improve the short-term prognosis.
Objective To investigate the curative effect and impact on short-term prognosis of levosimendan combined with recombinant human brain natriuretic peptide(rh-BNP)in treating patients with sepsis-induced cardiac dysfunction. Methods A total of 78 patients with sepsis-induced cardiac dysfunction were selected in Medical Scientific Academy of Sichuan & Sichuan Provincial People's Hospital from January 2014 to January 2017,and they were divided into control group and observation group according to random number table method,each with 39 cases. Patients in control group were given rh-BNP based on basic treatment,while patients in observation group were given levosimendan combined with rhBNP based on basic treatment. APACHE Ⅱ score,heart rate(HR),MAP,urine volume per hour,Cr,NT-proBNP before treatment,12 hours,24 hours,72 hours and 7 days after treatment,oxygenation index,global ejection fraction(GEF),cardiac index and ELWI before treatment,12 hours,24 hours and 72 hours after treatment were compared between the two groups,incidence of adverse reactions during treatment and death status 28 days after follow-up were observed. Results(1)There were statistically significant interaction in urine volume per hour and cardiac index between time and method(P<0.05),but there was no statistically significant interaction in APACHE Ⅱ score,HR,MAP,Cr,NT-proBNP,oxygenation index,GEF or ELWI between time and method(P>0.05);main effect of time was statistically significant in APACHE Ⅱ score,HR,urine volume per hour,Cr,GEF and cardiac index,respectively(P<0.05),but was not statistically significant in MAP,NT-proBNP,oxygenation index or ELWI(P>0.05);main effect of method was statistically significant in APACHE Ⅱscore,HR,urine volume per hour,GEF,cardiac index and ELWI(P<0.05),was not statistically significant in MAP,Cr,NT-proBNP or oxygenation index(P>0.05). After 72 hours of treatment,APACHE Ⅱ score,HR and ELWI in observation group were statistically significantly lower than those in control group,while urine volume per hour,GEF and CI in observation group were statistically significantly higher than those in control group(P<0.05);after 7 days of treatment,APACHE Ⅱ score in observation group was statistically significantly lower than that in control group,while urine volume per hour in observation group was statistically significantly higher than that in control group(P<0.05).(2)No one in the two groups occurred any serious adverse reactions.(3)Fatality rate in observation group was statistically significantly lower than that in control group 28 days after treatment(P<0.05). Conclusion In patients with sepsis-induced cardiac dysfunction,levosimendan combined with rh-BNP can effectively enhance the myocardial contractility,improve the cardiac function,gradually increase the urine volume,with relatively high safety,and is helpful to improve the short-term prognosis.
引文
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[4]付龙,郭亮,张月兰.重组人脑利钠肽治疗急性心力衰竭的血流动力学改变及临床疗效研究[J].中国全科医学,2014,17(17):1984-1988.DOI:10.3969/j.issn.1007-9572.2014.17.015.
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[9]蒋宗明,吴秀娟,仲俊峰,等.左西孟旦用于CPB心脏手术后患者低心排综合征的疗效[J].中华麻醉学杂志,2015,35(1):123-124.DOI:10.3760/cma.j.issn.0254-1416.2015.01.035.
[10]牛炳英,李博,王芙蕊,等.左西孟旦与米力农对充血性心力衰竭患者影响的对比研究[J].实用心脑肺血管病杂志,2018,26(5):67-69.DOI:10.3969/j.issn.1008-5971.2018.05.016.
[11]俞瑞群,王丹,吴晓蓉,等.左西孟旦治疗老年慢性心力衰竭急性加重患者的临床疗效[J].实用心脑肺血管病杂志,2018,26(5):88-90.DOI:10.3969/j.issn.1008-5971.2018.05.022.
[12]段立萍,卢英霞,杜晓燕,等.重组人脑利钠肽对急性前壁心肌梗死患者心功能及心肌损伤的影响[J].实用心脑肺血管病杂志,2018,26(9):89-92.DOI:10.3969/j.issn.1008-5971.2018.09.020.
[13]SONG Z,CUI Y,DING M Z,et al.Protective effects of recombinant human brain natriuretic peptide against LPS-Induced acute lung injury in dogs[J].Int Immunopharmacol,2013,17(3):508-512.DOI:10.1016/j.intimp.2013.05.028.
[14]吴金波,王雁娟,李明秋,等.重组人脑利钠肽对体外循环下心脏手术术后肾功能的影响[J].临床麻醉学杂志,2011,27(3):264-266.
[15]蒲虹,黄晓波.重组人脑利钠肽对脓毒症诱导心功能障碍的影响[J].临床麻醉学杂志,2016,32(3):213-216.
[2]WALLEY K R.Deeper understanding of mechanisms contributing to sepsis-induced myocardial dysfunction[J].Crit Care,2014,18(3):137.DOI:10.1186/cc13853.
[3]贾志,郭牧,张丽媛,等.左西孟旦对失代偿性心力衰竭患者近期心功能的影响[J].中国综合临床,2014,30(2):113-118.DOI:10.3760/cma.j.issn.1008-6315.2014.02.001.
[4]付龙,郭亮,张月兰.重组人脑利钠肽治疗急性心力衰竭的血流动力学改变及临床疗效研究[J].中国全科医学,2014,17(17):1984-1988.DOI:10.3969/j.issn.1007-9572.2014.17.015.
[5]高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505.DOI:10.3760/cma.j.issn.2095-4352.2013.08.016.
[6]LEFER A M.Role of a myocardial depressant factor in the pathogenesis of circulatory shock[J].Fed Proc,1970,29(6):1836-1847.DOI:10.1016/j.apcata.2014.12.009.
[7]HUNTER J D,DODDI M.Sepsis and the heart[J].Br J Anaesth,2010,104(1):3-11.DOI:10.1093/bja/aep339.
[8]张晓凡,李莉.脓毒症心肌损伤机制研究及治疗进展[J].中华急诊医学杂志,2015,24(3):339-341.DOI:10.3760/cma.j.issn.1671-0282.2015.03.027.
[9]蒋宗明,吴秀娟,仲俊峰,等.左西孟旦用于CPB心脏手术后患者低心排综合征的疗效[J].中华麻醉学杂志,2015,35(1):123-124.DOI:10.3760/cma.j.issn.0254-1416.2015.01.035.
[10]牛炳英,李博,王芙蕊,等.左西孟旦与米力农对充血性心力衰竭患者影响的对比研究[J].实用心脑肺血管病杂志,2018,26(5):67-69.DOI:10.3969/j.issn.1008-5971.2018.05.016.
[11]俞瑞群,王丹,吴晓蓉,等.左西孟旦治疗老年慢性心力衰竭急性加重患者的临床疗效[J].实用心脑肺血管病杂志,2018,26(5):88-90.DOI:10.3969/j.issn.1008-5971.2018.05.022.
[12]段立萍,卢英霞,杜晓燕,等.重组人脑利钠肽对急性前壁心肌梗死患者心功能及心肌损伤的影响[J].实用心脑肺血管病杂志,2018,26(9):89-92.DOI:10.3969/j.issn.1008-5971.2018.09.020.
[13]SONG Z,CUI Y,DING M Z,et al.Protective effects of recombinant human brain natriuretic peptide against LPS-Induced acute lung injury in dogs[J].Int Immunopharmacol,2013,17(3):508-512.DOI:10.1016/j.intimp.2013.05.028.
[14]吴金波,王雁娟,李明秋,等.重组人脑利钠肽对体外循环下心脏手术术后肾功能的影响[J].临床麻醉学杂志,2011,27(3):264-266.
[15]蒲虹,黄晓波.重组人脑利钠肽对脓毒症诱导心功能障碍的影响[J].临床麻醉学杂志,2016,32(3):213-216.