祛瘀解毒利水法(血必净和加味苓桂术甘汤)辅助治疗对脓毒症心肌病患者预后的影响  

Therapy of Dispelling Stasis,Removing Toxin,and Promoting Urination(Xuebijing Injection Combined with Modified Linggui Zhugantang)Affects Prognosis of Sepsis-induced Cardiomyopathy

作　　者：许梅 段明明 杨明华 赵津 赵一鸣 施保柱 XU Mei;DUAN Mingming;YANG Minghua;ZHAO Jin;ZHAO Yiming;SHI Baozhu(Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050011,China;Hebei University of Chinese Medicine,Shijiazhuang 050200,China)

机构地区：[1]河北省中医院,石家庄050011 [2]河北省中医学院,石家庄050200

出　　处：《中国实验方剂学杂志》2023年第7期146-152,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省中医药管理局科研计划项目(2022062)。

摘　　要：目的:评价祛瘀解毒利水法(血必净和加味苓桂术甘汤)辅助治疗对脓毒症心肌病(SICM)患者预后的影响。方法:将96例患者随机分为观察组和对照组,每组各48例。对照患者给予脓毒症集束化治疗;观察组在对照组的基础上给予祛瘀解毒利水法治疗(血必净注射液静脉滴注和加味苓桂术甘汤内服),两组疗程均为7 d。评估两组患者病情和预后评估指标[28 d死亡率,重症监护室(ICU)住院时间,主要不良心血管事件(MACE)、急性生理和慢性健康评分Ⅱ(APACHEⅡ)、脓毒症相关序贯器官衰竭评估(SOFA)评分、急诊脓毒症死亡风险评分(MEDS)]、心功能指标[左室射血分数(LVEF)、舒张早期二尖瓣血流速度/舒张晚期二尖瓣血流速度(E/A)、舒张早期二尖瓣血流速度/二尖瓣环舒张早期运动速度(E/e′)、后负荷校正心功能参数(ACP)]、心肌损伤标志[高敏心肌肌钙蛋白T(hs-cTnT)、N-末端B型脑钠肽前体(NT-proBNP)、心肌型-脂肪酸结合蛋白(H-FABP)、高迁移率族蛋白-1(HMGB-1)]、血流动力学指标[血管外肺水指数(EVLWI)、全心舒张末期容积指数(GEDVI)、心脏指数(CI)和外周血管阻力指数(SVRI)]及中医证候评分。结果:与对照组比较,观察组28 d死亡率和MACE发生率均低于对照组,但差异无统计学意义;观察组ICU住院时间短于对照组(P<0.05)。与本组治疗前比较,两组患者治疗后APACHEⅡ、SOFA、MEDS和瘀毒内阻证评分、E/e′、hs-cTnT、NT-proBNP、H-FABP和HMGB1均明显降低(P<0.05),LVEF、E/A和ACP明显升高(P<0.05);与对照组治疗后比较,观察组改善更明显(P<0.05)。治疗后第3、5、7天,观察组患者EVLWI、SVRI低于对照组(P<0.05),CI高于对照组(P<0.05),在治疗后第3、5天,观察组GEDVI高于对照组(P<0.05)。结论:在西医常规集束化治疗的基础上,针对SICM病机特点进行祛瘀解毒利水法治疗,采用加味苓桂术甘汤联合血必净注射液辅助治疗,可抑制心肌损伤标志物�Objective:To evaluate the effect of the therapy of dispelling stasis,removing toxin,and promoting urination(modified Linggui Zhugantang combined with Xuebijing injection)on the prognosis of sepsis-induced cardiomyopathy(SICM).Method:A total of 96 patients were randomly assigned into an observation group and a control group,with 48 patients in each group.The patients in the control group received sepsis bundle,and those in the observation group additionally received the therapy of dispelling stasis,removing toxin,and promoting urination(intravenous drip of Xuebijing injection and oral administration of modified Linggui Zhugantang).The course of treatment in both groups was 7 days.The disease and prognosis indicators[28-day mortality,intensive care unit(ICU)length of stay,major adverse cardiac events(MACE),acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)score,and mortality in emergency department sepsis(MEDS)score],cardiac function indicators[left ventricular ejection fraction(LVEF),E/A ratio of peak velocity blood flow from left ventricular relaxation in early diastole(the E wave)to peak velocity flow in late diastole caused by atrial contraction(the A wave),E/e′ratio of mitral peak velocity of early filling(E)to early diastolic mitral annular velocity(e′),and afterload-corrected cardiac performance(ACP)],myocardial injury markers[high-sensitivity cardiac troponin T(hs-cTnT),N-terminal pro-brain natriuretic peptide(NT-proBNP),heart-type fatty acid-binding protein(H-FABP),and high mobility group box-1(HMGB-1)],hemodynamic indicators[extravascular lung water index(EVLWI),global enddiastolic volume index(GEDVI),cardiac index(CI),and systemic vascular resistance index(SVRI)],and TCM syndrome scores were assessed and compared between the two groups.Result:The 28-day mortality and the incidence of MACE in the observation group were slightly lower than those in the control group.The ICU length of stay in the observation group was shorter than that in the control g

关 键 词：脓毒症心肌病 祛瘀解毒利水法 苓桂术甘汤 血必净注射液 血流动力学 心功能 

分 类 号：R242[医药卫生—中医临床基础] R2-031[医药卫生—中医学] R287R259R542.2