清源生化汤对严重骨创伤后脓毒症患者心脏保护作用的临床研究  

Clinical research of Qingyuan Shenghua Decoction on cardio protection in patients with sepsis after severe bone trauma

作　　者：王凤英[1] 张国秀[2] 许利辉[1] 明松林[1] 尤莉莉[1] 李鹤[1] 宋青凤[1] 李良业[1] 

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)重症医学科,洛阳471002 [2]河南科技大学第一附属医院急诊科,洛阳471002

出　　处：《中华中医药杂志》2017年第1期382-385,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：河南省中医药科学研究专项课题(No.2013ZY02010)~~

摘　　要：目的:观察清源生化汤对严重骨创伤后脓毒症患者心肌损伤及心脏功能的影响。方法:将2013年3月-2014年12月河南省洛阳正骨医院重症医学科收治的60例严重骨创伤后脓毒症患者按随机数字表法分为中西医结合治疗组(32例)和西医对照组(28例)。两组均参照2012年严重脓毒症及脓毒性休克治疗国际指南进行西医常规治疗;中西医结合治疗组在常规西医治疗基础上,采用自制中药清源生化汤300m L,每日1剂,分2次服。两组疗程均为7d。分别于治疗前及治疗后1、3、7d采血,检测血浆肌酸激酶同工酶(CK-MB)、超敏心肌肌钙蛋白T(hs-c Tn T)及N末端脑利钠肽前体(NT-pro BNP)含量;治疗前及治疗后7d行彩色多普勒超声检查,测量左心室射血分数(LVEF)、舒张早期/晚期心室充盈速度最大值比值(E/A比值)、左室舒张期末容积指数(LVEDVI)及左室收缩期末容积指数(LVESVI)。结果:随治疗时间延长,两组CK-MB、hs-c Tn T和NT-pro BNP均明显改善,以中西医结合治疗组7d时hs-c Tn T、NT-Pro BNP改善更为明显(P<0.05);而两组各时间点CK-MB均无明显差异。治疗后7d,西医对照组仅E/A比值和LVEDI明显改善,而中西医结合治疗组各心功能指标均较治疗前明显改善,且明显优于西医对照组(P<0.05)。结论:清源生化汤联合西医常规疗法治疗严重骨创伤后脓毒症,可降低患者心肌受损程度、改善心功能,对心脏具有很好的保护作用。Objective：To observe the effect of Qingyuan Shenghua Decoction on myocardial injury and cardiac function in sepsis patients after severe bone trauma.Methods：Sixty sepsis patients after severe bone trauma admitted to Department of Critical Care Medicine of Luoyang Orthopedic-Traumatological Hospital of Henan Province from March 2013 to December2014 were randomly divided into treatment group（32 cases） and control group（28 cases）.The two groups were referenced to the international guide line of severe sepsis and septic shock in 2012 forroutine treatment of western medicine,and integrated traditional Chinese and western medicine treatment group was treated with the self-madetraditional Chinese medicineprescription additionally：Qingyuan Shenghua Decoction 300 mL,was dosed twice a day.Two groups were treated for 7 days.Blood samples were taken before treatment and at 1,3,7 days after treatment to measure the levels of plasmacreatine kinase isoenzyme（CKMB）,high sensitivecardiac troponin T（hs-cTnT） and N-terminal pro-brain natriuretic peptide（NT-proBNP）.Color Doppler ultrasound examination was performed before and 7 days after treatment to measure left ventricular ejection fraction（LVEF）,early diastolic/late ventricularfilling velocitymaximumratio（E/A ratio）,left ventricular end diastolic volume index（LVEDVI） and left ventricularend systolic volume index（LVESVI）.Results：With prolonged treatment,the CK-MB,hs-cTnT and NT-proBNP of two groups were significantly improved,and the integrated traditional Chinese and western medicine treatment group improved more obviously（P〈0.05）;and there was no significant difference in CK-MB between the two groups at each time point.Seven days after treatment,only the E/Aratio and LVEDI in the western medicinecontrol group were significantly improved,but all the cardiac function indexes in the integrated traditional Chinese and western medicine treatment group were significantly improved and obviously better than the western medicinecontrol g

关 键 词：清源生化汤 骨创伤 脓毒症 心肌损伤 心功能 

分 类 号：R641[医药卫生—外科学] R459.7[医药卫生—临床医学]