祛瘀解毒利水法对脓毒症心肌病右心功能障碍血流动力学影响  

Effect of Dispelling Blood Stasis,Removing Blood Stasis and Promoting Urination on Hemodynamics of Right Ventricular Dysfunction in Septic 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,Hebei,China;Hebei University Chinese Medicine,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北省中医院,河北石家庄050011 [2]河北中医药大学,河北石家庄050000

出　　处：《中华中医药学刊》2024年第10期218-223,共6页Chinese Archives of Traditional Chinese Medicine

基　　金：河北省中医药管理局科研计划项目(2022062)。

摘　　要：目的观察祛瘀解毒利水法辅助治疗脓毒症心肌病(sepsis-induced cardiomyopath,SICM)右心功能障碍的临床疗效及对血流动力学的影响。方法将60例患者随机分为观察组(30例)和对照组(30例)。对照组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50 mL,静脉滴注,2次/d,和加味苓桂术甘汤内服,1剂/d),两组疗程均为7 d。采用脉搏指示连续心输出量(pulse indicator continuous cardiac output,PiCCO)监测血流动力学指标[血管外肺水指数(extra vascular lung water index,EVLWI)、全心舒张末期容积指数(global end-diastolic volume index,GEDVI)、胸腔内血容积指数(intrathoracic blood volume index,ITBVI)及心脏功能指数(cardiac function index,CFI)和外周血管阻力指数(systemic vascular resistance index,SVRI)],测量治疗前后混合静脉血氧饱和度(saturation of venous oxygen,SvO_(2))、中心静脉血二氧化碳分压(partial pressure of carbon dioxide,PcvCO_(2))、血乳酸(blood lactic acid,Lac)、中心静脉-动脉血二氧化碳分压差(central venous-to-arterial carbon dioxide difference,Pcv-aCO_(2))=PcvCO_(2)-PaCO_(2)、左室射血分数(left ventricular ejection fraction,LVEF)、E/A、E/e′、右心室舒张末期面积(right ventricular end-diastolic area,RVEDA)/左心室舒张末期面积(left ventricular end-diastolic area,LVEDA)比值、三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE);检测治疗前后高敏心肌肌钙蛋白I(high-sensitivity cardiac troponin I,hs-cTnI)、N-末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)和高迁移率族蛋白B1(high mobility group protein B1,HMGB1);进行治疗前后急性生理及慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)和脓毒症相关序贯器官衰竭评分(sequential organ failure assessment,SOFA)评分。结果治疗后3~7 d,EVLWI、IObjective To observe the clinical effect of dispelling blood stasis,removing blood stasis and promoting urination in adjuvant treatment of right ventricular dysfunction in septic cardiomyopathy(SICM)and its effect on hemodynamics.Method Sixty patients were randomly divided into observation group(30 cases)and control group(30 cases).The patients in the control group were given bundle therapy for sepsis.On the basis of the control group,the patients in observation group were given the method of dispelling blood stasis,removing blood stasis and promoting urination[Xuebijing Injection(血必净注射液)50 mL,intravenous drip,2 times/day and Jiawei Linggui Zhugan Decoction(加味苓桂术甘汤)orally,1 dose/day].The course of treatment in both groups was 7 days.Pulse-indicated continuous cardiac output(PiCCO)was used to monitor hemodynamic parameters[extravascular lung water index(EVLWI),global end-diastolic volume index(GEDVI),intrathoracic blood volume index(ITBVI),index(CFI)and peripheral vascular resistance index(SVRI)].Before and after treatment,mixed venous oxygen saturation(SvO_(2)),central venous carbon dioxide partial pressure(PcvCO_(2)),blood lactate(Lac),central venous-arterial carbon dioxide partial pressure(Pcv-aCO_(2))=PcvCO_(2)-PaCO_(2),left ventricular ejection fraction(LVEF),E/A,E/e′,right ventricular end-diastolic area(RVEDA)/left ventricular end-diastolic area(LVEDA)ratio,tricuspid annular systolic displacement(TAPSE)were detected.The values of high-sensitivity cardiac troponin I(hs-cTnI),N-terminal precursor B-type natriuretic peptide(NT-proBNP),creatine kinase isoenzyme(CK-MB),high mobility group box protein B1(HMGB1),acute physiology and chronic health score(APACHE II)and sepsis-related sequential organ failure score(SOFA)before and after treatment were detected.Result On 3 to 7 day after treatment,the levels of EVLWI,ITBVI and SVRI gradually decreased(P<0.05),while the levels of GEDVI and CFI gradually increased(P<0.05).On the 3rd,5th and 7th day after treatment,the levels of EVLWI and SVRI

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

分 类 号：R259.422[医药卫生—中西医结合]