温阳化瘀解毒法治疗脓毒症心肌抑制的临床研究
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摘要
目的:探究温阳化瘀解毒法治疗脓毒症心肌抑制的临床效果。方法:选取本院ICU收治的脓毒症心肌损伤患者60例为研究对象,按照随机数字表法分为对照组(n=30例)和观察组(n=30例)。两组患者均给予西医常规治疗,对照组患者在常规处理基础上给予多巴酚丁胺静脉泵入治疗;观察组患者则在对照组基础上采用中医温阳化瘀解毒法治之,给予温阳化瘀解毒汤内服,疗程均为7d。通过中医症状积分变化评价温阳化瘀解毒法治疗脓毒症心肌抑制疗效,观察治疗前后心肌功能指标变化,监测心肌抑制因子内皮素-1(endothelin-1,ET-1)、白三烯(leukotrienes,LT)、高迁移率族蛋白B-1(high mobility group protein B-1,HMBG-1)水平,统计两组患者治疗前后的APACHE II评分、ICU住院时间及ICU内病死率。结果:治疗后,观察组患者的临床症状改善更为明显,其中医证候积分(8.12±3.04)分较对照组(11.75±4.31)分明显降低(P<0.05)。两组患者的心肌功能指标LVESD、LVEDD、BNP、cTnI2较治疗前明显降低,LVEF、CI水平则较治疗前明显升高(P<0.05);治疗后组间对比,观察组患者的LVESD、LVEDD、BNP、cTnI2水平明显低于对照组,而LVEF、CI水平则明显高于对照组(P<0.05);两组患者的心肌抑制因子ET-1、LT、HMBG-1水平均较同组治疗前下降,以观察组患者的水平更低(P<0.05);治疗后,观察组患者的APACHEII评分(13.52±3.29)分明显低于对照组的(20.45±5.37)分,其ICU住院时间(6.29±2.59)d较对照组的(12.14±4.35)d明显缩短,ICU病死率23.33%较对照组的43.33%更低(P<0.05)。结论:温阳化瘀解毒法利于改善脓毒症心肌抑制患者的中医证候,提高心肌收缩功能,改善患者的心功能,降低了心肌抑制因子水平,减轻心肌损害,缩短ICU住院时间,降低病死率,值得临床推广运用。
Objective:To explore the clinical effect of treatment of myocardial inhibition of sepsis by warming Yang-removing blood stasis-detoxifying therapy.Methods:Sixty patients with sepsis myocardial injury admitted and treated by ICU of our hospital were selected as the study subjects,and were divided into control group(n=30 cases)and observation group(n=30 cases)according to the random number table method.Both groups were received conventional treatment of western medicine.Patients in the control group were treated with intravenous infusion of dopamine phenolamine on the basis of routine treatment and those in the observation group were given warming Yang-removing blood stasis-detoxifying therapy with a course of treatment of 7 days.The paper was focus on comparing the clinical effect by the change of TCM symptom score,observing the changes in cardiac function indexes before and after treatment,monitoring the levels of ET-1,LT and HMBG-1 and recording the two groups of patients before and after treatment of APACHE II score,ICU length of hospital stayand case fatality rate in ICU.Results:After treatment,the clinical symptoms of the patients in the observation group improved significantly,and TCM syndromes score(8.12±3.04)was significantly lower than that of the control group(11.75±4.31)(P<0.05).The myocardial function indexes of LVESD,LVEDD,BNP and cTnI2 in the two groups were significantly lower than before treatment,while the LVEF and CI levels were significantly higher than before treatment(P<0.05).After treatment,LVESD,LVEDD,BNP and cTnI2 levels of patients in the observation group were significantly lower than those in the control group,while LVEF and CI levels were significantly higher than those in the control group(P<0.05).The levels of ET-1,LTand HMBG-1 of the two groups of patients were lower than those of the same group before treatment so as to lower the level of patients in the observation group(P<0.05).After treatment,the observation group's APACHEII scores(13.52±3.29)points was significantly lower than the control group's(20.45±5.37)points and the ICU length of hospital stay(6.29±2.59)d was shorter than the control group's(12.14±4.35)d.The case fatality rate in ICU was 23.33%,which was lower than that of the control group's 43.33%(P<0.05).Conclusion:Treatment of myocardial inhibition of sepsis by warming Yang-removing blood stasis-detoxifying therapy is good to improve myocardial suppression of TCM syndrome,the myocardial systolic function and the patients' heart function,reduce the levels of myocardial suppressor,lower myocardial damage,shorten ICU length of hospital stay and reduce the case fatality rate,worthy of clinical promotion.
Objective:To explore the clinical effect of treatment of myocardial inhibition of sepsis by warming Yang-removing blood stasis-detoxifying therapy.Methods:Sixty patients with sepsis myocardial injury admitted and treated by ICU of our hospital were selected as the study subjects,and were divided into control group(n=30 cases)and observation group(n=30 cases)according to the random number table method.Both groups were received conventional treatment of western medicine.Patients in the control group were treated with intravenous infusion of dopamine phenolamine on the basis of routine treatment and those in the observation group were given warming Yang-removing blood stasis-detoxifying therapy with a course of treatment of 7 days.The paper was focus on comparing the clinical effect by the change of TCM symptom score,observing the changes in cardiac function indexes before and after treatment,monitoring the levels of ET-1,LT and HMBG-1 and recording the two groups of patients before and after treatment of APACHE II score,ICU length of hospital stayand case fatality rate in ICU.Results:After treatment,the clinical symptoms of the patients in the observation group improved significantly,and TCM syndromes score(8.12±3.04)was significantly lower than that of the control group(11.75±4.31)(P<0.05).The myocardial function indexes of LVESD,LVEDD,BNP and cTnI2 in the two groups were significantly lower than before treatment,while the LVEF and CI levels were significantly higher than before treatment(P<0.05).After treatment,LVESD,LVEDD,BNP and cTnI2 levels of patients in the observation group were significantly lower than those in the control group,while LVEF and CI levels were significantly higher than those in the control group(P<0.05).The levels of ET-1,LTand HMBG-1 of the two groups of patients were lower than those of the same group before treatment so as to lower the level of patients in the observation group(P<0.05).After treatment,the observation group's APACHEII scores(13.52±3.29)points was significantly lower than the control group's(20.45±5.37)points and the ICU length of hospital stay(6.29±2.59)d was shorter than the control group's(12.14±4.35)d.The case fatality rate in ICU was 23.33%,which was lower than that of the control group's 43.33%(P<0.05).Conclusion:Treatment of myocardial inhibition of sepsis by warming Yang-removing blood stasis-detoxifying therapy is good to improve myocardial suppression of TCM syndrome,the myocardial systolic function and the patients' heart function,reduce the levels of myocardial suppressor,lower myocardial damage,shorten ICU length of hospital stay and reduce the case fatality rate,worthy of clinical promotion.
引文
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[13] 黄强,余华东,毛素芳.血浆内皮素-1水平与急性心肌梗死患者自发再灌注的关系研究[J].临床和实验医学杂志,2018,17(11):1175-1178.
[14] Ferrer R,Martínez ML,Gomà G,et al.mproved empirical antibiotic treatment of sepsis after an educational intervention:the ABISS-Edusepsis study[J].Crit Care,2018,22(1):167.
[15] 陆地,俞国峰,吕铁,等.参麦注射液联合血液灌流对脓毒症休克患者心肌抑制的影响[J].中华全科医学,2018,16(6):929-931,973.
[16] 王东东,吴彦青,王晓鹏,等.脓毒症心肌损伤机制及中医药诊疗现状[J].北京中医药,2018,37(2):186-191.
[17] 梁立新,吴彦青,狄浩然,等.当代医家论治脓毒症心肌抑制经验探析[J].北京中医药,2017,36(5):439-442.
[18] 赵雷,钱风华,沈梦雯,等.升降散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.
[19] 李亚萍,张俊林.降钙素原、胆碱酯酶及心肌肌钙蛋白Ⅰ在脓毒症患者病情及预后评估中的应用价值[J].新乡医学院学报,2017,34(12):1111-1113.
[20] 冯宣云,艾山木,刘琼.HMGB1在脓毒症心肌损害小鼠中的表达及炎症促进作用研究[J].重庆医科大学学报,2017,42(5):509-514.
[2] Buechter M,Gerken G,Hoyer DP,et al.Liver maximum capacity (LiMAx)test as a helpful prognostic tool in acute liver failure with sepsis:a case report [J].BMC Anesthesiol,2018,18 (1):71.
[3] Raeven P,Zipperle J,Drechsler S.Extracellular Vesicles as Markers and Mediators in Sepsis[J].Theranostics,2018,8(12):3348-3365.
[4] Oki M,Jesmin S,Islam MM,et al.Dual blockade of endothelin action exacerbates up-regulated VEGF angiogenic signaling in the heart of lipopolysaccharideinducedendotoxemic rat model[J].Life Sciences,2014,118(2):364-369.
[5] 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.
[6] 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):557-569.
[7] 中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[8] 中华人民共和国卫生部.中药新药临床研究指导原则(第1辑)[S].北京:人民卫生出版社,1993:58-59.
[9] 尤荣开.神经科危重症监测治疗学[M].北京:人民军医出版社,2004:82-85.
[10] 林乐清,金光勇.脓毒症心肌抑制发病机制的分子研究进展[J].医学研究杂志,2017,46(9):195-198.
[11] 黄永光,霍保善,罗威.脓毒症心肌抑制对脓毒症患者心功能及预后的影响研究[J].中国医药科学,2017,7(19):224-226.
[12] Parrillo JE,Burch C,Shelhamer JH,et al.circulating myocardial depressant substance in humans with septic shock.Septic shock patients with a reduced ejection fraction have a circulating factor that depressesin vitro myocardial cell performance[J].J Clin Invest,1985,76:1539-1553.
[13] 黄强,余华东,毛素芳.血浆内皮素-1水平与急性心肌梗死患者自发再灌注的关系研究[J].临床和实验医学杂志,2018,17(11):1175-1178.
[14] Ferrer R,Martínez ML,Gomà G,et al.mproved empirical antibiotic treatment of sepsis after an educational intervention:the ABISS-Edusepsis study[J].Crit Care,2018,22(1):167.
[15] 陆地,俞国峰,吕铁,等.参麦注射液联合血液灌流对脓毒症休克患者心肌抑制的影响[J].中华全科医学,2018,16(6):929-931,973.
[16] 王东东,吴彦青,王晓鹏,等.脓毒症心肌损伤机制及中医药诊疗现状[J].北京中医药,2018,37(2):186-191.
[17] 梁立新,吴彦青,狄浩然,等.当代医家论治脓毒症心肌抑制经验探析[J].北京中医药,2017,36(5):439-442.
[18] 赵雷,钱风华,沈梦雯,等.升降散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.
[19] 李亚萍,张俊林.降钙素原、胆碱酯酶及心肌肌钙蛋白Ⅰ在脓毒症患者病情及预后评估中的应用价值[J].新乡医学院学报,2017,34(12):1111-1113.
[20] 冯宣云,艾山木,刘琼.HMGB1在脓毒症心肌损害小鼠中的表达及炎症促进作用研究[J].重庆医科大学学报,2017,42(5):509-514.