脓毒症心力衰竭患者血清心肌肌钙蛋白I的相关性及五参汤治疗的临床疗效观察  

Correlation analysis of serum cardiac troponin I and clinical efficacy observation of Wushen decoction for treatment of patients with sepsis heart failure

作　　者：李旭成[1] 张栋[1] 张军[1] 喻灿[1] 高宇[1] 余淑菁[1] 潘泉利[1] 余莉萍[1] Li Xucheng Zhang Dong Zhang Jun Yu Can Gao Yu Yu Shujing Pan Quanli Yu Liping(Department of Emergency, WuHan Hospital of Traditional Chinese Medicine, WuHan 430014, HuBei, China)

机构地区：[1]湖北省武汉市中医医院急诊科,湖北武汉430014

出　　处：《中国中西医结合急救杂志》2017年第1期10-13,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：湖北省武汉市医药卫生临床医学科研项目（WZ13C04）

摘　　要：目的观察五参汤对脓毒症心力衰竭（心衰）患者血清心肌肌钙蛋白I（cTnI）及心肌酶学和临床指标水平的影响，并分析cTnI与心肌酶学水平和临床指标的相关性。方法选择2014年3月至2016年3月武汉市中医医院收治的脓毒症患者42例，采用单盲完全随机化方法分为五参汤治疗组和对照组，每组21例。对照组采用常规西医治疗，五参汤治疗组在西医常规治疗基础上加用五参汤（由西洋参、苦参、北沙参、南沙参、丹参、黄芪、三七、降香等组成），每日1剂，两组疗程均为7d。比较两组治疗前和治疗后7d生化指标[cTnI、肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）]、血流动力学指标[心排血指数（CI）、中心静脉压（GVP）、血管外肺水指数（ELWI）、全心射血分数（GEF）、平均动脉压（MAP）、心率（HR）]、治疗情况及预后指标[血管活性药物用量指数、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、机械通气时间、重症加强治疗病房（ICU）住院时间、总住院时间]的变化；分析入院治疗前cTnI水平与CK、CK—MB、APACHEⅡ评分、血管活性药物用量指数、机械通气时间、ICU住院时间和总住院时间的相关性。结果两组治疗后cTnI、CK、CK—MB、CVP、ELWI、HR、血管活性药物用量指数、APACHE11评分均较治疗前明显降低，CI、GEF、MAP较治疗前明显升高，机械通气时间、ICU住院时间、总住院时间均较治疗前明显缩短，且以五参汤治疗组上述指标的变化较对照组更显著[cTnI（mg／L）：0．94±0．29比1．30±0．67，CK（U／L）：96．00±24．30比101．38±24．55，CK—MB（U／L）：31．14±6．78比36．48±8．17，CI（mL·s^-1·m^-2）：64．51±5．83比53．34±4．67，CVP（cmH2O，1cmH2O=0．098kPa）：10．56±1．84比11．94±2．16，ELWI（mL／kg）：8．81±1．61比11．66±2．30，GEF：（33．62±3．88）％比（27．1Objective To investigate the effect of Wushen decoction on levels of serum cardiac troponin I （cTnI）, cardiac muscle enzyme and clinical parameters in patients with sepsis heart failure, and to analyze the correlations between cTnI and myocardial enzyme level and clinical parameters. Methods Forty-two patients diagnosed as sepsis admitted to Wuhan Hospital of Traditional Chinese Medicine from March 2014 to March 2016 were enrolled, and they were divided into a Wushen decoction treatment group and a control group by principle of single blind complete randomized method, 21 cases in each group. The patients in control group were treated by conventional western medicine, while the patients in Wushen decoction treatment group, on the basis of conventional western medicine, they were treated additionally by Wushen decoction （composed of ginseng, radix sophorae flaveseentis, radix glehniae, radix adenophorae, salvia, astragalus, notoginseng radix, rosewood, etc.）, one dose a day, the therapeutic course in both groups being 7 days. The changes of biochemical indicators [cTnI, creatine kinase （CK）, CK isoenzyme （CK-MB）], haemodynamics parameters [cardiac index （CI）, central venous pressure （CVP）, extravascular lung water index （ELWI）, global ejection fraction （GEF）, mean arterial pressure （MAP）, heart rate （HR）], treatment condition and prognostic parameters [vasoactive drug dosage index, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, duration of mechanical ventilation, the length of stay in intensive care unit （ICU） and total hospitalization time] were compared before and after treatment for 7 days in the two groups. The correlations between the level of cTnI on admission before treatment and CK, CK-MB, APACHE Ⅱ , vasoactive drug dosage index, duration of mechanical ventilation, the length of stay in ICU and total hospitalization time were analyzed. Results The levels of cTnI, CK, CK-MB, CVP, ELWI, HR, vasoactive drug dosage index, APACHE Ⅱ scor

关 键 词：五参汤 脓毒症心力衰竭 相关性分析 临床疗效 

分 类 号：R541[医药卫生—心血管疾病]