酚妥拉明对脓毒症心肌损伤患者心功能、心肌损伤指标及血流动力学的影响  

Effects of phentolamine on cardiac function,myocardial injury index,and hemodynamics in septic patients with myocardial injury

作　　者：袁法伟[1] 冯辉斌[1] 尹欢[2] 郑鲲[1] 梅喜平[1] 袁利学[1] 邵碧波[1] 祝小梅[1] Fawei Yuan;Huibin Feng;Huan Yin;Kun Zheng;Xiping Mei;Lixue Yuan;Bibo Shao;Xiaomei Zhu(Department of Intensive Care Unit,Huangshi Central Hospital,Edong Healthcare Group,Affiliated Hospital of Hubei Polytechnic University,Hubei 435000,Hubei Province,China;Department of Neonatology ICU,Huangshi Maternity&Child Health Hospital,Edong Healthcare Group,Huangshi 435000,Hubei Province,China)

机构地区：[1]鄂东医疗集团黄石市中心医院湖北理工学院附属医院重症医学科,黄石435000 [2]鄂东医疗集团黄石市妇幼保健院新生儿科重症监护室,黄石435000

出　　处：《中国基层医药》2023年第1期63-67,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：湖北省卫生健康委员会联合基金(WJ2019H461)。

摘　　要：目的:观察酚妥拉明治疗脓毒症心肌损伤(SMD)的效果,并分析其对患者心功能、心肌损伤指标及血流动力学的影响。方法:回顾性分析鄂东医疗集团黄石市中心医院2017年2月至2020年2月收治的SMD患者79例的临床资料,以是否联合酚妥拉明治疗分为对照组41例、观察组38例,比较两组临床效果及治疗前后心功能、心肌损伤指标及血流动力学指标。结果:两组28 d病死率差异无统计学意义(P>0.05)。观察组重症监护病房(ICU)入住时间、机械通气时间分别为(9.33±3.52)d、83.00(28.50,138.00)h,均显著短于对照组的(12.17±4.15)d、111.00(47.50,169.00)h(t=3.26,Z=-2.27,均P<0.05)。观察组有效率为81.58%(31/38),显著高于对照组的60.98%(25/41)(χ^(2)=4.05,P<0.05)。治疗后7 d,两组左心室射血分数(LVEF)均显著高于治疗前(均P<0.05),左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)均显著低于治疗前(均P<0.05);观察组LVEF显著高于对照组(t=3.29,P<0.05),LVEDD、LVESD均显著低于对照组(t=5.94、11.21,均P<0.05)。两组患者N-末端原脑利钠肽(NT-proBNP)、心肌肌钙蛋白I(cTnI)均随着时间的延长而显著下降(均P<0.05);治疗后24 h、治疗后72 h、治疗后7 d,观察组NT-proBNP、cTnI水平均显著低于对照组(均P<0.05)。治疗后7 d,两组心率(HR)均显著低于治疗前(均P<0.05),平均动脉压(MAP)、心脏指数(CI)、每搏输出量指数(SVI)均显著高于治疗前(均P<0.05);观察组HR显著低于对照组(t=4.90,P<0.05),MAP、CI、SVI均显著高于对照组(t=4.37、3.23、6.01,均P<0.05)。结论:酚妥拉明可改善SMD患者血流动力学,减轻心肌损伤,提高心功能。Objective To investigate the efficacy of phenolamine in the treatment of sepsis-induced myocardial dysfunction and its effect on cardiac function,myocardial injury index,and hemodynamics in patients.Methods The clinical data of 79 patients with sepsis-induced myocardial dysfunction who received treatment in Huangshi Central Hospital,Edong Healthcare Group from February 2017 to February 2020 were retrospectively analyzed.These patients were divided into a control group(without phenolamine treatment,n=41)and an observation group(with phenolamine treatment,n=38)according to whether they received phenolamine treatment or not.Clinical efficacy,cardiac function,myocardial injury index,and hemodynamic index pre-and post-treatment were compared between the two groups.Results There was no significant difference in 28-day mortality rate between the two groups(P>0.05).Intensive care unit length of stay and mechanical ventilation duration in the observation group were(9.33±3.52)days and 83.00(28.50,138.00)hours,which were significantly shorter than(12.17±4.15)days and 111.00(47.50,169.00)hours in the control group(t=3.26,Z=-2.27,both P<0.05).The response rate in the observation group was significantly higher than that in the control group[81.58%(31/38)vs.60.98%(25/41),χ^(2)=4.05,P<0.05].After 7 days of treatment,the left ventricular ejection fraction in each group was significantly increased,and the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in each group were significantly decreased compared with before treatment(all P<0.05).After 7 days of treatment,the left ventricular ejection fraction in the observation group was significantly higher than that in the control group(t=3.29,P<0.05),and left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly lower than those in the control group(t=5.94,11.21,both P<0.05).N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in each group were significantly decreased with time(both P<0.0

关 键 词：休克 脓毒性 酚妥拉明 心脏功能试验 肌细胞 心脏 利钠肽 脑 肌钙蛋白I 血流动力学 心率 动脉压 每搏输出量 

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