左西孟旦对脓毒症患者心肌损伤的影响  

Effect of levosimendan on myocardial injury in patients with sepsis

作　　者：杨磊 易斌 Yang Lei;Yi Bin(Emergency Medical Center,Yinzhou Second Hospital,Ningbo 315100,Zhejiang Province,China)

机构地区：[1]宁波市鄞州区第二医院急救医学中心,315100

出　　处：《中国基层医药》2021年第4期533-537,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:探讨左西孟旦对脓毒症患者心肌损伤影响。方法:选取宁波市鄞州区第二医院2015年6月至2017年9月收治的脓毒症伴心肌损伤患者82例,采用随机数字表法分为对照组和治疗组,各41例,在常规基础治疗上,对照组予以多巴酚丁胺治疗,治疗组给予左西孟旦治疗。比较两组治疗前后心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)、N-末端脑钠钛前体(NT-proBNP)、左室射血分数(LVEF)、急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)的变化及ICU住院时间、28 d生存情况。结果:治疗前,两组患者H-FABP、cTnI、NT-proBNP各指标及LVEF、APACHEⅡ评分等差异均无统计学意义(均P>0.05);治疗后6 h,两组患者H-FABP、cTnI、NT-proBNP水平[(26.22±7.22)μg/L比(39.93±9.85)μg/L,(25.97±6.93)μg/L比(34.86±8.55)μg/L,(0.004±0.002)μg/L比(1.580±0.360)μg/L,(0.003±0.003)μg/L比(0.760±0.210)μg/L,(1561.73±633.70)ng/L比(2570.06±747.95)ng/L,(1602.28±681.45)ng/L比(2225.53±585.14)ng/L]均较治疗前升高,差异均有统计学意义(t=7.188、5.172、28.031、23.079、6.586、4.443,均P<0.05),治疗组患者治疗后H-FABP、cTnI、NT-proBNP水平均低于对照组(t=2.489、12.598、2.323,均P<0.05);治疗后72 h,两组H-FABP水平均较治疗后6 h降低[(39.93±9.85)μg/L比(6.28±1.07)μg/L,(34.86±8.55)μg/L比(5.82±1.88)μg/L],cTnI、NT-proBNP水平均较治疗后6 h升高[(1.58±0.36)μg/L比(2.72±0.55)μg/L,(0.76±0.21)μg/L比(1.78±0.49)μg/L,(2570.06±747.95)ng/L比(3623.27±1105.28)ng/L,(2225.53±585.14)ng/L比(3128.08±1098.07)ng/L],差异均有统计学意义(t=11.105、12.251、5.053、4.645,均P<0.05)。治疗后72 h,对照组cTnI、NT-proBNP水平均高于治疗组(t=8.171、2.035,均P<0.05),两组患者H-FABP水平比较差异无统计学意义(P>0.05);两组患者治疗后72 h的APACHEⅡ评分较治疗前降低、LVEF较治疗前提高,差异均有统计学意义(t=7.718、11.380,9.049、9.501,均P<0.05),治疗组与对照组相比,APACHEⅡ评分改善程度Objective To investigate the effect of levosimendan on myocardial injury in patients with sepsis.Methods Eighty-two patients with sepsis complicated by myocardial injury who received treatment in Yinzhou Second Hospital from June 2015 to September 2017 were included in this study.They were randomly assigned to receive either dobutamine treatment(control group,n=41)or levosimendan treatment(study group,n=41)based on conventional basic treatment.Before and after treatment,serum levels of heart-type fatty acid-binding protein(H-FABP),cardiac troponin I(cTnI),N-terminal pro brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LEVF),Acute Physiology,Age,and Chronic Health Evaluation II(APACHE II)score,intensive care unit(ICU)stay,and 28-day mortality were compared between the control and study groups.Results Before treatment,there were no significant differences in serum levels of H-FABP,cTnI,and NT-proBNP as well as LVEF and APACHE II score between the control and study groups(all P>0.05).At 6 hours after treatment,serum levels of H-FABP,cTnI,and NT-proBNP in the control and study groups[(26.22±7.22)μg/L vs.(39.93±9.85)μg/L,(25.97±6.93)μg/L vs.(34.86±8.55)μg/L,(0.004±0.002)μg/L vs.(1.580±0.360)μg/L,(0.003±0.003)μg/L vs.(0.760±0.210)μg/L,(1561.73±633.70)ng/L vs.(2570.06±747.95)ng/L,(1602.28±681.45)ng/L vs.(2225.53±585.14)ng/L]were significantly increased compared with before treatment(t=7.188,5.172,28.031,23.079,6.586,4.443,all P<0.05).After treatment,serum levels of H-FABP,cTnI,and NT-proBNP in the study group were significantly lower than those in the control group(t=2.489,12.598,2.323,all P<0.05).In each group,serum level of H-FABP at 72 hours after treatment was significantly lower than that at 6 hours after treatment[(39.93±9.85)μg/L vs.(6.28±1.07)μg/L,(34.86±8.55)μg/L vs.(5.82±1.88)μg/L],serum levels of cTnI and NT-proBNP at 72 hours after treatment were significantly increased compared with those at 6 hours after treatment[(1.58±0.36)μg/L vs.(2.72±0.55)μg/L,(0.

关 键 词：脓毒症 心肌挫伤 心型脂肪酸结合蛋白 肌钙蛋白I N-末端脑钠钛前体 急性生理学和慢性健康状况Ⅱ评分 左西孟旦 多巴酚丁胺 

分 类 号：R459.7[医药卫生—急诊医学] R542.2[医药卫生—治疗学]