心脉隆注射液对脓毒性心肌病机械通气患者心脏功能的影响
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摘要
目的:观察心脉隆注射液对脓毒性心肌病机械通气患者心功能的影响。方法:43例患者随机分为心脉隆治疗组(n=23)和对照组(n=20)。所有患者均采用无差别对症支持治疗。治疗组在常规治疗基础上,加以心脉隆注射液静脉滴注,5 d为1个疗程。记录2组患者入ICU时、治疗d 3和d 6心功能相关指标,包括左室射血分数(LVEF)、二尖瓣侧壁瓣环处舒张早期峰值速度(E')、左室舒张末期直径(LVDD)和脑钠肽(BNP)。同时,记录机械通气时间、住ICU时间、5 d内停用血管活性药物病例数及28 d病死率。结果:两组患者入院和治疗d 3的LVEF,E',LVDD和BNP无统计学差异(P> 0. 05)。治疗d 6时,治疗组LVEF和E'较对照组明显改善,而LVDD和BNP水平较对照组明显下降,具有统计学差异(P <0. 05)。治疗组机械通气时间和住ICU时间均短于对照组,具有统计学差异(P=0. 001,P=0. 024)。两组5 d内停用血管活性药物的病例数存在统计学差异(P=0. 043),但两组死亡病例数无统计学差异(P=0. 052)。结论:心脉隆注射液可改善脓毒性心肌病患者心脏功能、降低BNP、缩短机械通气时间和入住ICU时间,有降低病死率的趋势。
Objective: To observe the effect of Xinmailong injection on cardiac function in patients with mechanical ventilation of septic cardiomyopathy. Methods: Forty-three patients were randomly divided into the Xinmailong treatment group(23 cases) and the control group(20 cases). All patients were treated with indiscriminate symptomatic support. The treatment group received intravenous infusion of Xinmailong injection on the basis of routine treatment,and 5 d was a course of treatment. The third and sixth day of cardiac function related indicators of the two groups of patients in the ICU were recorded,including: LVEF,E',LVDD and BNP. At the same time,the mechanical ventilation time,the ICU time,the number of vasoactive drugs stopped in five days and the 28-day mortality rate were recorded. Results: There were no significant differences in LVEF,E',LVDD,and BNP between the two groups on the third day of admission and treatment(P > 0. 05). On the sixth day,the LVEF and E' of the treatment group were significantly improved compared with the control group,while the levels of LVDD and BNP were significantly lower than those of the control group,and the difference was statistically significant(P < 0. 05). The mechanical ventilation time and ICU time in the treatment group were shorter than those in the control group,with statistical difference(P = 0. 001,P = 0. 024). There was a statistically significant difference inthe number of cases with vasoactive drugs discontinued within 5 days(P = 0. 043). However,there was no significant difference in the number of deaths between the two groups(P = 0. 052). Conclusion: Xinmailong injection can improve cardiac function,reduce BNP,shorten mechanical ventilation time and ICU stay time,and has a tendency to reduce the mortality rate in patients with sepsis cardiomyopathy.
Objective: To observe the effect of Xinmailong injection on cardiac function in patients with mechanical ventilation of septic cardiomyopathy. Methods: Forty-three patients were randomly divided into the Xinmailong treatment group(23 cases) and the control group(20 cases). All patients were treated with indiscriminate symptomatic support. The treatment group received intravenous infusion of Xinmailong injection on the basis of routine treatment,and 5 d was a course of treatment. The third and sixth day of cardiac function related indicators of the two groups of patients in the ICU were recorded,including: LVEF,E',LVDD and BNP. At the same time,the mechanical ventilation time,the ICU time,the number of vasoactive drugs stopped in five days and the 28-day mortality rate were recorded. Results: There were no significant differences in LVEF,E',LVDD,and BNP between the two groups on the third day of admission and treatment(P > 0. 05). On the sixth day,the LVEF and E' of the treatment group were significantly improved compared with the control group,while the levels of LVDD and BNP were significantly lower than those of the control group,and the difference was statistically significant(P < 0. 05). The mechanical ventilation time and ICU time in the treatment group were shorter than those in the control group,with statistical difference(P = 0. 001,P = 0. 024). There was a statistically significant difference inthe number of cases with vasoactive drugs discontinued within 5 days(P = 0. 043). However,there was no significant difference in the number of deaths between the two groups(P = 0. 052). Conclusion: Xinmailong injection can improve cardiac function,reduce BNP,shorten mechanical ventilation time and ICU stay time,and has a tendency to reduce the mortality rate in patients with sepsis cardiomyopathy.
引文
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[13]陈剑峰,薛书峰,段卡丹,等.心脉隆注射液治疗急性心力衰竭的对照研究[J].中西医结合心脑血管病杂志,2017,15(9):1039-1040.
[14] HAMZAOUI O,GEORGER JF,MONNET X,et al. Early administration of norepinephrine increases cardiac preload and cardiac 0utput in septic patients with life-threatening hypotension[J]. Crit Care,2010,14(4):R142.
[2]李真玉,陈兵.脓毒症心肌抑制的诊治进展[J].中国循环杂志,2015,30(7):705-707.
[3]卢年芳,席修明.感染性心肌病的研究进展[J/OL].中华重症医学电子杂志,2016,2(3):199-204.
[4] SINGER M,DEUTSCHMAN CS,SEYMOUR CW,et al. The third international consensus definitions for sepsis and septicshock(sepsis-3)[J]. JAMA,2016,315(8):801-810.
[5] NAGUEH SF,APPLETON CP,GILLEBERT TC,et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography[J]. Eur J Echocardiogr,2009,10(2):165-193.
[6] VIEILLARD-BARON A. Septic cardiomyopathy[J]. Ann Intensive Care,2011,1(1):6.
[7] REDFORS B,VEDAD R,ANGERAS O,et al. Mortality in takotsubo syndrome is similar to mortality in myocardial infarction-a report from the SWEDEHEART registry[J]. Int J Cardiol,2015(185):282-289.
[8] KAKIHANA Y,ITO T,NAKAHARA M,et al. Sepsis-induced myocardial dysfunction:pathophysiology and management[J]. J Intensive Care,2016,4(1):22.
[9]李莉,严静,陈昌勤,等.线粒体损伤在脓毒症大鼠心肌细胞凋亡中的作用[J].中华急诊医学杂志,2012,21(11):1221-1225.
[10] HOBAII A,EDGECOMB J,LABARGE K,et al. Dysregulation of intracellular calcium transporters in animal models of sepsis induced cardiomyopathy[J]. Shock,2015,43(1):3-15.
[11] PAARY TT,KALAISELVAN MS,RENUKA MK,et al. Clinical profile and outcome of patients with severe sepsis treated in an intensive care unit in India[J]. Ceylon Med J,2016,61(4):181-184.
[12]金东,王钦贤,王结胜.左西孟旦治疗急性失代偿期心力衰竭50例疗效分析[J/CD].中华危重症医学杂志(电子版),2014,7(6):38-42.
[13]陈剑峰,薛书峰,段卡丹,等.心脉隆注射液治疗急性心力衰竭的对照研究[J].中西医结合心脑血管病杂志,2017,15(9):1039-1040.
[14] HAMZAOUI O,GEORGER JF,MONNET X,et al. Early administration of norepinephrine increases cardiac preload and cardiac 0utput in septic patients with life-threatening hypotension[J]. Crit Care,2010,14(4):R142.