益气解毒汤加减治疗脓毒症心肌损伤的疗效观察  

Clinical Observation on Therapeutic Effect of Modified Yiqi Jiedu Decoction on Sepsis-induced Myocardial Dysfunction

作　　者：吴洁 丘文凤 廖金明 曾志威[2] WU Jie;QIU Wen-feng;LIAO Jin-ming;ZENG Zhi-wei(Department of Intensive Care Unit,Meizhou People's Hospital,Meizhou Guangdong 514000;Department of Traditional Chinese Medicine,Meizhou People's Hospital,Meizhou Guangdong 514000)

机构地区：[1]梅州市人民医院重症医学科,广东梅州514000 [2]梅州市人民医院中医科,广东梅州514000

出　　处：《世界中西医结合杂志》2025年第2期302-307,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：广东省中医药局中医药科研项目(20232184)。

摘　　要：目的观察益气解毒汤加减治疗脓毒症心肌损伤(Sepsis-induced myocardial dysfunction,SIMD)患者的效果。方法选取2022年1月—2023年12月期间梅州市人民医院重症医学科收治的112例SIMD患者,按随机数字表法分为对照组和观察组,每组各56例。对照组给予西药常规治疗,观察组给予益气解毒汤加减联合西药常规治疗,疗程均为7 d。观察比较两组患者治疗前后的序贯器官衰竭评分(Sequential organ failure assessment,SOFA)、血清心肌功能指标[肌钙蛋白I(Cardiac troponin I,cTnI)、B型脑钠肽(Brain natriuretic peptide,BNP)、肌酸激酶同工酶-MB(Creatine kinase-MB,CK-MB)]、中医证候积分、心脏彩超指标[左室舒张末期内径(Left ventricular end diastolic diameter,LVEDD)、左室射血分数(Left ventricular ejection fraction,LVEF)、心排血量(Cardiac output,CO)]、急性生理与慢性健康Ⅱ(Acute physiology and chronic healthⅡ,APACHEⅡ)评分,统计疗效,并记录临床治疗第7天病死率和28 d累计病死率。结果治疗后两组患者SOFA、APACHEⅡ评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组SOFA、APACHEⅡ评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者心肌功能BNP、cTnI及CK-MB指标均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组心肌功能BNP、cTnI及CK-MB指标均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者LVEDD指标均较治疗前降低,LVEF、CO指标较治疗前升高,差异有统计学意义(P<0.05);且观察组LVEDD指标明显低于对照组,LVEF、CO指标明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者热毒炽盛证高热大汗、气粗喘息、大渴饮冷、咽痛、头痛、便秘、小便短赤及总评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组热毒炽盛证高热大汗、气粗喘息、大渴饮冷、咽痛、头痛、便秘、小便短赤及总评分均明显低于对照Objective To explore the effect of modified Yiqi Jiedu Decoction in treating sepsis-induced myocardial dysfunction(SIMD).Methods A total of 112 patients with SIMD treated in the Intensive Care Unit(ICU)of Meizhou People's Hospital between January 2022 and December 2023 were enrolled and randomly divided into a control group and an observation group according to a random number table,with 56 patients in each group.The control group received conventional Western medicine treatment,while the observation group received modified Yiqi Jiedu Decoction combined with conventional Western medicine treatment,with a treatment duration of 7 days for both groups.The sequential organ failure assessment(SOFA)score,serum myocardial function markers[cardiac troponin I(cTnI),brain natriuretic peptide(BNP),creatine kinase-MB(CK-MB)],traditional Chinese medicine(TCM)syndrome scores,echocardiographic parameters[left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),cardiac output(CO)],and Acute Physiology and Chronic Health I(APACHE I)scores in both groups were observed and compared before and after treatment.Clinical efficacy was assessed,and the 7-day and 28-day cumulative mortality rates were recorded.Results After treatment,the SOFA and APACHE II scores in both groups decreased significantly compared to those before treatment(P<0.05).The scores in the observation group were significantly lower than those in the control group(P<0.05).After treatment,myocardial function markers(BNP,cTnI,and CK-MB)in both groups were significantly reduced compared to those before treatment(P<0.05).The observation group had significantly lower BNP,cTnl,and CK-MB levels than the control group(P<0.05).After treatment,the LVEDD in both groups was significantly reduced,while the LVEF and CO were significantly increased compared to those before treatment(P<0.05).The observation group showed a significantly lower LVEDD and significantly higher LVEF and CO than the control group(P<0.05).Regarding TCM syndrome scores,after tre

关 键 词：益气解毒汤加减 热毒炽盛证 脓毒症心肌损伤 瘀毒内阻证 心肌功能 

分 类 号：R542.2[医药卫生—心血管疾病]