乌司他丁联合大黄治疗对严重脓毒症心肌损伤的影响  

The effect of ulinastatin associated with rhubarb on myocardial injury in patients with severe sepsis

作　　者：徐杰[1] 宋樱花[1] 马明远[1] 潘永[1] 张兴胜[1] 丘运兰[1] 

机构地区：[1]广东省佛山市中医院ICU,广东佛山528000

出　　处：《中国中西医结合急救杂志》2012年第3期159-161,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省佛山市医学类科技攻关项目（200908019）

摘　　要：目的探讨乌司他丁（UTI）联合大黄对严重脓毒症患者心肌损伤的影响。方法将60例严重脓毒症患者[急性生理学与慢性健康状况评分系统Ⅱ（APACHEII）≥25分]按随机原则分为3组，对照组采用常规治疗，UTI组在对照组基础上加用UTI，联合组在对照组础上加用UTI联合大黄，每组20例。观察治疗5d后心肌肌钙蛋白I（cTnI）、N末端B型钠尿肽前体（NT-proBNP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C-反应蛋白（CRP）等指标变化，记录心排血量（CO）、APACHE1／评分、住重症监护病房（ICU）时间。结果对照组、UTI组、联合组治疗后CO均明显升高，cTnI、NT-proBNP、TNF-α、1L-6、CRP、APACHEII评分均明显降低，以联合组变化更显著[CO（L／min）：3．1I±0．72比2．88±0．58、2．99±0．53，cTnI（μg／L）：1．01±0．22比1．33±0．45、1．26±0．37，NT-proBNP（ng／L）：987．4±327．5比1378．6±373．4、1102．8±371．5。TNF-α（ng／L）：2．01±0．35比2．40±0．54、2．24±0．41，IL-6（ng／L）：21．84±9．26比38．14±10．22、35．54±11．55，CRP（mg／L）：21．5±8．4比58．2±11．7、44.7±13．4，APACHE11评分（分）：19．90±11．56比28．87±14．66、24．62±10．45，均P〈0．05]，联合组住ICU时间较对照组明显缩短（d：10．13±2．65比16．62±4．87，P〈0．05）。结论UTI联合大黄治疗对严重脓毒症患者损伤心肌具有保护作用。Objective To approach the effect of ulinastatin （UTI） associated with rhubarb on myocardial injury in patients with severe sepsis. Methods Sixty patients with severe sepsis and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score ≥25 were randomly divided into three groups, with 20 patients in each group. All the three groups received the routine treatment, additionally, the UTI group was treated with UTI and the combined group, UTI associated with rhubarb. The venous blood was collected to determine serum cardiac troponin I （cTnI）, N-terrainsl pro-B-type natriuretic peptide （NT-proBNP）, tumor necrosis factor- α （TNF- α）, interleukin-6 （IL-6）, and C-reactive protein （CRP）, ere before the therapy and on the 5th day after therapy. The cardiac output （CO） and APACHE Ⅱ score were observed before and after therapy and the duration in intensive care unit （ICU）was recorded. Results After treatment in the three groups, the CO was significantly higher, while cTnI, NT-proBNP, TNF-α, IL-6, CRP and APACHE Ⅱ score were obviously lower, and all the above indexes in combined group were changed most significantly [ CO （L/rain） ： 3.11±0.72 vs. 2.88±0.58, 2.99±0.53, cTnI （μg/L） ： 1.01±0.22 vs. 1.33±0.45, 1.26±0.37, NT-proBNP （ng/L） ： 987.4±327.5 vs. 1378.6±373.4, 1102.8±371.5, TNF-α （ng/L） ： 2.01±0.35 vs. 2.40±0.54, 2.24±0.41, IL-6 （ng/L） ： 21.84±9.26 vs. 38.14±10.22, 35.54±11.55, CRP （mg/L） ： 21.5±8.4 vs. 58.2±11.7, 44.7±13.4, APACHE Ⅱ score ： 19.90±11.56 vs. 28.87±14.66, 24.62±10.45, all P〈 0.051, the duration in ICU of combined group was markedly shorter than that in control group （days ： 10.13±2.65 vs. 16.62±4.87, P〈0.05）. Conclusion UTI associated with rhubarb has protective effects on myocardial injury in patients with severe sepsis.

关 键 词：乌司他丁 大黄 脓毒症 心肌损伤 急性生理学与慢性健康状况评分系统Ⅱ评分 中药 

分 类 号：R285.6[医药卫生—中药学] R256.2[医药卫生—中医学]