左卡尼汀联合心理干预对感染性心内膜炎患者的疗效分析
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摘要
目的分析左卡尼汀联合心理干预对感染性心内膜炎(IE)患者血清炎性介质及临床抗感染的疗效情况。方法选取2015年3月-2017年3月于医院进行治疗的IE患者128例为研究对象,随机分为对照组和试验组,各64例;对照组使用左卡尼汀同时进行常规康复干预,试验组在对照组基础上进行心理干预;观察患者临床疗效及不良反应状况,检测患者治疗前后血清血沉(ESR)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)及降钙素原(PCT)情况,观察患者治疗后住院时间、病发率及赘生物缩小率状况。结果试验组疗效优于对照组(P=0.006);治疗后患者血清PCT、ESR、IL-6及CRP含量较治疗前降低(P<0.05),且试验组以上指标分别为(0.05±0.01)ng/ml、(13.25±3.89)mm/h、(95.42±25.38)mg/L、(7.96±3.51)mg/L低于对照组(P<0.05);试验组患者住院时间、赘生物缩小率及病死率均分别为(11.25±2.51)天、75.48%及3.13%(2/64)与对照组比较差异有统计学意义(P<0.05);对照组不良反应总发生率为14.06%(9/64);试验组总发生率为7.81%(5/64),差异无统计学意义(P=0.384)。结论左卡尼汀联合心理干预可降低IE患者血清炎性因子含量,提高治疗效果,改善患者预后,具有一定的临床价值。
OBJECTIVE To analyze the curative effect of levocarnitine combined with psychological intervention in serum inflammatory mediators and anti-infection of infective endocarditis(IE) patients. METHODS 128 cases of IE patients treated in the hospital from Mar. 2015 to Mar. 2017 were enrolled and randomly divided into two groups, with 64 cases in each group. The control group(64 cases) was treated with L-carnitine and conventional nursing, whereas the observation group(64 cases) received psychological intervention in addition to the treatment of the control group. The clinical efficacy and adverse reactions in patients were observed, changes in ESR(ESR), C reactive protein(CRP), interleukin-6(IL-6) and procalcitonin(PCT) levels before and after treatment were measured, and the hospitalization time, morbidity rate and the reduction rate of vegetation after treatment were observed. RESULTS The clinical efficacy of the experimental group was significantly better than that of the control group(P=0.006). The serum levels of PCT, ESR, IL-6 and CRP were significantly lower than those before treatment(P<0.05), and the above indexes in the experimental group were(0.05±0.01) ng/ml,(13.25±3.89) mm/h,(95.42±25.38) g/L,(7.96±3.51) mg/L, all significantly lower than those in the control group(P<0.05). The hospitalization time, vegetation reduction rate and the mortality rate in the experimental group were(11.25±2.51) days, 75.48% and 3.13%(2/64), there were sighificant differences between the experimental group and the control group(P<0.05). The total incidence of adverse reactions in the control group was 14.06%(9/64), and the total incidence of adverse reactions in the experimental group was 7.81%(5/64). The difference was not significant(P=0.384). CONCLUSION L-carnitine combined with psychological intervention can significantly reduce the serum content of inflammatory factors in IE patients, improve the therapeutic effect, and improve the prognosis of patients. So it has a certain clinical value.
OBJECTIVE To analyze the curative effect of levocarnitine combined with psychological intervention in serum inflammatory mediators and anti-infection of infective endocarditis(IE) patients. METHODS 128 cases of IE patients treated in the hospital from Mar. 2015 to Mar. 2017 were enrolled and randomly divided into two groups, with 64 cases in each group. The control group(64 cases) was treated with L-carnitine and conventional nursing, whereas the observation group(64 cases) received psychological intervention in addition to the treatment of the control group. The clinical efficacy and adverse reactions in patients were observed, changes in ESR(ESR), C reactive protein(CRP), interleukin-6(IL-6) and procalcitonin(PCT) levels before and after treatment were measured, and the hospitalization time, morbidity rate and the reduction rate of vegetation after treatment were observed. RESULTS The clinical efficacy of the experimental group was significantly better than that of the control group(P=0.006). The serum levels of PCT, ESR, IL-6 and CRP were significantly lower than those before treatment(P<0.05), and the above indexes in the experimental group were(0.05±0.01) ng/ml,(13.25±3.89) mm/h,(95.42±25.38) g/L,(7.96±3.51) mg/L, all significantly lower than those in the control group(P<0.05). The hospitalization time, vegetation reduction rate and the mortality rate in the experimental group were(11.25±2.51) days, 75.48% and 3.13%(2/64), there were sighificant differences between the experimental group and the control group(P<0.05). The total incidence of adverse reactions in the control group was 14.06%(9/64), and the total incidence of adverse reactions in the experimental group was 7.81%(5/64). The difference was not significant(P=0.384). CONCLUSION L-carnitine combined with psychological intervention can significantly reduce the serum content of inflammatory factors in IE patients, improve the therapeutic effect, and improve the prognosis of patients. So it has a certain clinical value.
引文
[1] 张美静,孟蕾.感染性心内膜炎赘生物早期识别、治疗及护理进展[J].中国实用护理杂志,2016,32(13):190-191.
[2] Baddour LM,Wilson WR,Bayer AS,et al.Infective endocarditis:diagnosis,antimicrobial therapy,and management of complications:a statement for healthcare professionals from the Committee on Rheumatic Fever,Endocarditis,and Kawasaki Disease,Council on Cardiovascular Disease in the Young,and the Councils on Clinical Cardiology,Stroke,and Cardiovascular Surgery and Anesthesia,American Heart Association:endorsed by the Infectious Diseases Society of America[J].Circulation,2005,111(23):394-434.
[3] 陈伟宁,何爱玉.肺部感染并发心力衰竭患者血清心肌酶谱及B型尿钠肽水平变化研究[J].中华医院感染学杂志,2012,22(6):1178-1179.
[4] 林志强,陈婷婷,傅新阳,等.替考拉宁在耐甲氧西林金黄色葡萄球菌所致感染性心内膜炎的应用评价[J].中国医院药学杂志,2017,37(11):1092-1096.
[5] Hartman L,Barnes E,Bachmann L,et al.Opiate injection-associated infective endocarditis in the southeastern United States[J].Am J Med Sci,2016,352(6):603-606.
[6] Carrel T,Englberger L,Takala J.What's new in surgical treatment of infective endocarditis?[J].Intensive Care Med,2016,42(12):2052-2054.
[7] 马永德,王君霞.左卡尼汀联合生脉注射液治疗小儿病毒性心肌炎临床疗效观察[J].山西医药杂志,2016,45(16):1902-1904.
[8] Padmaja K,Sudhaharan S,Vemu L,et al.Clinicomicrobiological spectrum of infective endocarditis - from a tertiary care centre in south India[J].Iran J Microbiol,2017,9(5):257-263.
[9] Francischetto O,Silva LA,Senna KM,et al.Healthcare-associated infective endocarditis:a case series in a referral hospital from 2006 to 2011[J].Arq Bras Cardiol,2014,103(4):292-298.
[10] 潘嘉西,章敏学,姜进克,等.左卡尼汀辅助抗菌药物对感染性心内膜炎患者血清cTnⅠ与PCT及ESR的影响[J].中华医院感染学杂志,2018,28(12):1798-1801.
[11] Rushani D,Kaufman JS,Ionescuittu R,et al.Infective endocarditis in children with congenital heart disease:cumulative incidence and predictors[J].Circulation,2013,128(13):1412-1419.
[12] 王晓蕾,孟莉莉.左卡尼汀联合百令胶囊对慢性肾衰行腹膜透析患者微炎症、营养状况和生活质量的影响[J].海军医学杂志,2017,38(1):80-82.
[13] 顾燕,金梅,郑可,等.先天性心脏病合并感染性心内膜炎42例临床分析[J].心肺血管病杂志,2014,33(2):227-231.
[14] Elikowski W,Mitkowski P,Matekelikowska M,et al.Acalculous cholecystitis in a female with cardiac device-related infective endocarditis[J].Pol Merkur Lekarski,2017,43(255):125-128.
[15] 纪晓燕,陈珏,张志胜,等.心理护理对乙型肝炎后肝纤维化患者抑郁状态及生存质量的改善[J].实用临床医药杂志,2016,20(24):137-139,150.
[16] 安浩君,陈惠刚,李霞,等.感染性心内膜炎患者分离株铜绿假单胞菌耐药基因研究[J].中国病原生物学杂志,2014,15(12):1071-1074.
[17] 梁燕.妊娠期感染性心内膜炎9例护理体会[J].武警医学,2017,28(8):853-855.
[18] Habib G,Lancellotti P,Antunes MJ,et al.2015 ESC Guidelines for the management of infective endocarditis The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by:European Association for Cardio-Thoracic Surgery (EACTS),the European Association of Nuclear Medicine (EANM)[J].Eur Heart J,2015,36(44):3075-3128.
[19] Cahill TJ,Baddour LM,Habib G,et al.Challenges in Infective endocarditis[J].J Am Coll Cardiol,2017,69(3):325-344.
[20] Suarez Bagnasco M,Nunez-Gil IJ.Infective endocarditis and thoracic aortic disease:a review on forgotten psychological aspects[J].World J Cardiol,2017,9(7):620-628.
[21] Rosenthal ES,Karchmer AW,Theisen-Toupal J,et al.Suboptimal addiction interventions for patients hospitalized with injection drug use associated infective endocarditis[J].Am J Med,2016,129(5):481-485.
[22] Levitas A,Krymko H,Richardson J,et al.Recombinant tissue plasminogen activator as a novel treatment option for infective endocarditis:a retrospective clinical study in 32 children[J].Cardiol Young,2016,26(1):110-115.
[23] Byrd VS,Nemeth AS.A Case of infective endocarditis and spinal epidural abscess caused by Streptococcus mitis bacteremia[J].Case Rep Infect Dis,2017,2017:7289032.
[2] Baddour LM,Wilson WR,Bayer AS,et al.Infective endocarditis:diagnosis,antimicrobial therapy,and management of complications:a statement for healthcare professionals from the Committee on Rheumatic Fever,Endocarditis,and Kawasaki Disease,Council on Cardiovascular Disease in the Young,and the Councils on Clinical Cardiology,Stroke,and Cardiovascular Surgery and Anesthesia,American Heart Association:endorsed by the Infectious Diseases Society of America[J].Circulation,2005,111(23):394-434.
[3] 陈伟宁,何爱玉.肺部感染并发心力衰竭患者血清心肌酶谱及B型尿钠肽水平变化研究[J].中华医院感染学杂志,2012,22(6):1178-1179.
[4] 林志强,陈婷婷,傅新阳,等.替考拉宁在耐甲氧西林金黄色葡萄球菌所致感染性心内膜炎的应用评价[J].中国医院药学杂志,2017,37(11):1092-1096.
[5] Hartman L,Barnes E,Bachmann L,et al.Opiate injection-associated infective endocarditis in the southeastern United States[J].Am J Med Sci,2016,352(6):603-606.
[6] Carrel T,Englberger L,Takala J.What's new in surgical treatment of infective endocarditis?[J].Intensive Care Med,2016,42(12):2052-2054.
[7] 马永德,王君霞.左卡尼汀联合生脉注射液治疗小儿病毒性心肌炎临床疗效观察[J].山西医药杂志,2016,45(16):1902-1904.
[8] Padmaja K,Sudhaharan S,Vemu L,et al.Clinicomicrobiological spectrum of infective endocarditis - from a tertiary care centre in south India[J].Iran J Microbiol,2017,9(5):257-263.
[9] Francischetto O,Silva LA,Senna KM,et al.Healthcare-associated infective endocarditis:a case series in a referral hospital from 2006 to 2011[J].Arq Bras Cardiol,2014,103(4):292-298.
[10] 潘嘉西,章敏学,姜进克,等.左卡尼汀辅助抗菌药物对感染性心内膜炎患者血清cTnⅠ与PCT及ESR的影响[J].中华医院感染学杂志,2018,28(12):1798-1801.
[11] Rushani D,Kaufman JS,Ionescuittu R,et al.Infective endocarditis in children with congenital heart disease:cumulative incidence and predictors[J].Circulation,2013,128(13):1412-1419.
[12] 王晓蕾,孟莉莉.左卡尼汀联合百令胶囊对慢性肾衰行腹膜透析患者微炎症、营养状况和生活质量的影响[J].海军医学杂志,2017,38(1):80-82.
[13] 顾燕,金梅,郑可,等.先天性心脏病合并感染性心内膜炎42例临床分析[J].心肺血管病杂志,2014,33(2):227-231.
[14] Elikowski W,Mitkowski P,Matekelikowska M,et al.Acalculous cholecystitis in a female with cardiac device-related infective endocarditis[J].Pol Merkur Lekarski,2017,43(255):125-128.
[15] 纪晓燕,陈珏,张志胜,等.心理护理对乙型肝炎后肝纤维化患者抑郁状态及生存质量的改善[J].实用临床医药杂志,2016,20(24):137-139,150.
[16] 安浩君,陈惠刚,李霞,等.感染性心内膜炎患者分离株铜绿假单胞菌耐药基因研究[J].中国病原生物学杂志,2014,15(12):1071-1074.
[17] 梁燕.妊娠期感染性心内膜炎9例护理体会[J].武警医学,2017,28(8):853-855.
[18] Habib G,Lancellotti P,Antunes MJ,et al.2015 ESC Guidelines for the management of infective endocarditis The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)Endorsed by:European Association for Cardio-Thoracic Surgery (EACTS),the European Association of Nuclear Medicine (EANM)[J].Eur Heart J,2015,36(44):3075-3128.
[19] Cahill TJ,Baddour LM,Habib G,et al.Challenges in Infective endocarditis[J].J Am Coll Cardiol,2017,69(3):325-344.
[20] Suarez Bagnasco M,Nunez-Gil IJ.Infective endocarditis and thoracic aortic disease:a review on forgotten psychological aspects[J].World J Cardiol,2017,9(7):620-628.
[21] Rosenthal ES,Karchmer AW,Theisen-Toupal J,et al.Suboptimal addiction interventions for patients hospitalized with injection drug use associated infective endocarditis[J].Am J Med,2016,129(5):481-485.
[22] Levitas A,Krymko H,Richardson J,et al.Recombinant tissue plasminogen activator as a novel treatment option for infective endocarditis:a retrospective clinical study in 32 children[J].Cardiol Young,2016,26(1):110-115.
[23] Byrd VS,Nemeth AS.A Case of infective endocarditis and spinal epidural abscess caused by Streptococcus mitis bacteremia[J].Case Rep Infect Dis,2017,2017:7289032.