四逆汤联合血液净化对脓毒症患者心肌损伤标志物及短期预后的影响  

Effect of Sini Decoction Combined with Blood Purification on Myocardial Injury Markers and Short-term Prognosis in Patients with Sepsis

作　　者：李华[1] 孙治霞[1] 张娟娟[1] 臧宾宾[1] 李琰[1] 胡仕祥[1] LI Hua;SUN Zhi-xia;ZHANG Juan-juan;ZANG Bin-bin;LI Yan;HU Shi-xiang(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou Henan 450002)

机构地区：[1]河南省中医院,河南郑州450002

出　　处：《世界中西医结合杂志》2022年第9期1807-1810,1814,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：河南省高等学校重点科研项目计划(21A320009)。

摘　　要：目的观察四逆汤联合连续性血液净化(Continuous blood purification,CBP)对脓毒症患者心肌损伤标记物及短期预后的影响。方法选取2020年7月—2021年7月期间河南省中医院收治的120例脓毒症患者作为研究对象,采用随机数字表法将患者分为观察组和对照组,每组各60例。两组患者均接受CBP治疗,观察组在此基础上联合应用四逆汤。治疗5 d后,观察比较两组患者治疗前后血清白介素-6(Interleukin-6,IL-6)、IL-8及肿瘤坏死因子-ɑ(Tumor necrosis factor-ɑ,TNF-ɑ)炎性因子表达水平,血浆N-末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、血清心型脂肪酸结合蛋白(Heart-type fatty acid-binding protein,H-FABP)及可溶性髓系细胞触发受体-1(Souble triggering receptor expressed on myeloid cells-1,sTREM-1)心肌标记物水平;比较两组患者28 d病死率及分析影响患者28 d病死率的影响因素。结果观察组58例入组,28 d死亡7例,病死率12.07%。对照组55例入组,28 d死亡19例,病死率34.55%。观察组28 d病死率低于对照组,两组比较,差异有统计学意义(P<0.05)。治疗5 d后两组患者血清IL-6、IL-8、TNF-ɑ、血浆NT-proBNP、血清H-FABP、血清sTREM-1水平均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组血清IL-6、IL-8、TNF-ɑ、血浆NT-proBNP、血清H-FABP、血清sTREM-1水平明显低于对照组,差异有统计学意义(P<0.05)。Cox风险回归模型分析显示APACHEⅡ评分(OR=1.968,95%CI=1.207~3.209,P=0.007)、血清IL-6(OR=1.309,95%CI=1.032~1.660,P=0.026)、血浆NT-proBNP(OR=1.907,95%CI=1.221~2.978,P=0.005)、血清H-FABP(OR=2.796,95%CI=1.461~5.351,P=0.002)、血清sTREM-1(OR=2.146,95%CI=1.162~3.963,P=0.015)及四逆汤干预(OR=0.679,95%CI=0.582~0.792,P<0.001)是脓毒症患者死亡的独立影响因素。结论四逆汤联合CBP治疗脓毒症有助于抑制心肌标记物和炎性因子表达,改善短期预后。Objective To study the effect of Sini decoction combined with continuous blood purification(CBP)on myocardial injury markers and short-term prognosis in patients with sepsis.Methods A total of 120 patients with sepsis treated in Henan Province Hospital of Traditional Chinese Medicine from July 2020 to July 2021 were collected as the research objects,and they were divided into observation group and control group by random number table,60 in each group.The two groups were treated with CBP,and the observation group was combined with Sini decoction on this basis.The treatment lasted for 5 days,The expression levels of serum inflammatory factors interleukin-6(IL-6),interleukin-8(IL-8)and tumor necrosis factor-ɑ(TNF-ɑ)were recorded before and after treatment.The plasma N-terminal proatrial B-type natriuretic peptide(NT-proBNP),serum heart-type fatty acid-binding protein(H-FABP)and soluble triggering receptors expressed on myeloid cells-1(sTREM-1)myocardial markers were compared between the two groups.In addition,the 28 day mortality of the two groups was compared,and the influencing factors were analyzed.Results A total of 58 cases were finally enrolled in the observation group,and 7 cases died in 28 days,with the fatality rate of 12.07%;55 cases were enrolled in the control group,and 19 cases died in 28 days,with the fatality rate of 34.55%.There was significant difference between the two groups in the 28 day mortality(P<0.05).The serum levels of IL-6,IL-8 and TNF-ɑ,plasma NT-proBNP,serum H-FABP and serum sTREM-1 in the observation group after 5 days of treatment were lower than those in the control group(P<0.05).The Cox regression model analysis showed that Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score(OR=1.968,95%CI=1.207-3.209,P=0.007),serum IL-6(OR=1.309,95%CI=1.032-1.660,P=0.026),plasma NT-proBNP(OR=1.907,95%CI=1.221-2.978,P=0.005),serum H-FABP(OR=2.796,95%CI=1.461-5.351,P=0.002),serum sTREM-1(OR=2.146,95%CI=1.162-3.963,P=0.015)and Sini decoction intervention(OR=0.679,95%CI=0.582-0.792,P<0.

关 键 词：四逆汤 血液净化 脓毒症 心肌损伤标记物 短期预后 

分 类 号：R631[医药卫生—外科学]