黄连解毒汤联合西药治疗脓毒症心肌损伤疗效研究  

Study on clinical efficacy of Huanglian Jiedu decoction combined with western medicine on myocardial injury caused by sepsis

作　　者：龙敏 张玉琴[1] 岳煜[1] 张雨梅 杨云华[1] 刘建 孟庆娥 王芳[1] 祁中兰 LONG Min;ZHANG Yuqin;YUE Yu;ZHANG Yumei;YANG Yunhua;LIU Jian;MENG Qing’e;WANG Fang;QI Zhonglan(The Second Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210017,China)

机构地区：[1]南京中医药大学第二附属医院,江苏南京210017

出　　处：《陕西中医》2022年第3期329-333,共5页Shaanxi Journal of Traditional Chinese Medicine

基　　金：江苏省中医药管理局科研项目(YB2020026);江苏省第二中医院院内课题(SEZ202123)。

摘　　要：目的:探讨黄连解毒汤治疗脓毒血症心肌损伤(SIMD)患者的临床疗效和预后。方法:选取68例SIMD患者,随机为对照组(n=34)和观察组(n=34)。对照组给予集束化等综合治疗,观察组在对照组基础上联合运用黄连解毒汤。比较两组心肌损伤指标[心肌肌钙蛋白I(cTnI)、氨基末端脑钠肽前体(NT-proBNP)和肌酸激酶同工酶(CK-MB)]、心功能指标[左心射血分数(LVEF)、左室舒张早期快速充盈的充盈峰和心房收缩充盈的充盈峰(E/A)、心脏每搏输出量(SV)]、血清超氧化物歧化酶(SOD)、乳酸(Lac)、降钙素原(PCT)水平。比较两组应用急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、中医证候评分、临床疗效及预后。结果:治疗后,两组血清cTnI、NT-ProBNP、CK-MB水平均降低,且观察组低于对照组,差异有统计学意义(均P<0.01)。治疗后,LVEF、E/A、SV水平均升高,且观察组以上指标水平高于对照组,差异有统计学意义(均P<0.01)。与治疗前比较,治疗后两组血清PCT、Lac水平均降低,SOD升高,差异有统计学意义(均P<0.01)。治疗后,观察组血清PCT、Lac水平低于对照组,SOD水平高于对照组,差异有统计学意义(均P<0.01)。治疗后,两组APACHEⅡ、SOFA、中医证候评分降低,观察组以上评分均低于对照组,差异有统计学意义(均P<0.01)。观察组总有效率高于对照组,观察组ICU转出率高于对照组,差异有统计学意义(均P<0.05)。结论:黄连解毒汤联合西药治疗脓毒症心肌损伤可提高临床疗效,减轻心肌损伤,保护心肌组织,改善预后。Objective:To investigate the effect of Huanglian Jiedu decoction on clinical efficacy and prognosis of patients with sepsis-induced myocardial injury(SIMD).Methods:68 patients with SIMD were randomly divided into control group(n=34)and observation group(n=34).The control group was given cluster therapy and other comprehensive treatment.The observation group was treated with Huanglian Jiedu decoction on the basis of the control group.The cardiac injury indexes[cardiac troponin I(cTnI),amino-terminal brain natriuretic peptide precursor(NT-proBNP)and creatine kinase isoenzyme(CK-MB)],cardiac function indexes[left ventricular ejection fraction(LVEF),filling peak of early left ventricular diastolic rapid filling and filling peak of atrial contraction filling(E/A),and cardiac output per stroke(SV)],serum superoxide dismutase(SOD),lactic acid(Lac)and procalcitonin(PCT)levels were compared between the two groups.Acute physiology and chronic health status scoreⅡ(APACHEⅡ),sequential organ failure(SOFA)score,TCM syndrome score,clinical efficacy and prognosis were compared between the two groups.Results:After treatment,the levels of serum cTnI,NT-proBNP and CK-MB in both groups were decreased,and above indicators in the observation group were lower than the control group,difference statistically significant(all P<0.01).After treatment,the levels of LVEF,E/A and SV were increased,and above indicators in the observation group were higher than those in the control group,difference statistically significant(all P<0.01).Compared with before treatment,after treatment the levels of serum PCT and Lac were decreased,SOD increased,difference statistically significant(all P<0.01).After treatment,the levels of serum PCT and Lac in the observation group were lower than those in the control group,and SOD higher than that in the control group,difference statistically significant(all P<0.01).After treatment,the scores of APACHEⅡ,SOFA and TCM syndrome in both groups decreased,and above scores in the observation group were lower than th

关 键 词：脓毒症 心肌损伤 黄连解毒汤 心功能 心肌酶 

分 类 号：R542.2[医药卫生—心血管疾病]