黄芪注射液对脓毒症患者心肌损伤干预作用的观察

An investigation of intervention of Radix astragali injection （黄芪注射液） on critically ill patients with septic myocardial injury

目的 探讨黄芪注射液对伴发心肌损伤脓毒症患者受损心肌的干预作用.方法 将55例脓毒症及脓毒性休克伴发心肌损伤患者随机分为对照组（25例）及治疗组（30例）.对照组采用极化液治疗,治疗组在对照组基础上加用黄芪注射液30 ml静脉滴注,每日1次,两组均连用2周.观察两组患者治疗后1、5、10 d血肌钙蛋白I（cTnI）及心功能变化情况.结果 对照组各时间点血cTnI水平无明显变化;治疗组治疗后5 d、10 d cTnI水平均较治疗1 d明显降低,且明显低于对照组[5 d：（0.83±0.60） μg/L比（1.50±1.48） μg/L,10 d：（0.61±0.52） μg/L比（1.26±1.23） μg/L,均P＜0.05].36例存活者治疗5 d、10 d cTnI水平明显低于19例死亡者[5 d：（0.67±0.49） μg/L比（1.61±1.40） μg/L,10 d：（0.52±0.45） μg/L比（1.32±1.17） μg/L,均P〈0.05].治疗组和对照组心肌抑制发生率及治疗前局部室壁运动/左室舒张期充盈（E/A）比较差异无统计学意义;治疗2周后治疗组E/A较对照组明显升高（1.4±0.3比1.1±0.2）,且心肌抑制恢复时间明显短于对照组[室壁运动恢复时间：（7.0±0.6） d比（11.0±0.8） d,左室舒张功能恢复时间：（4.0±0.5） d比（8.0±0.8） d,P〈0.05或P＜0.01].结论 黄芪注射液对脓毒症患者受损心肌有较强的保护作用,可提早恢复受抑制心肌的功能.

Objective To study the effects of Radix astragali injection （黄芪注射液） on injured myocardium in severe septic patients with myocardial injury. Methods Fifty-five patients clinically diagnosed as severe sepsis/sepsis shock were randomly divided into a treatment group （30 cases） and a control group （25 cases）. The polarized solution was used in both groups, and the Radix astragali injection 30 ml intravenous drip was additionally used in the treatment group once a day. Sequentially, the course of treatment of two groups was 2 weeks. The level of cardiac tropinin I （cTnI） and the cardiac functions of the 1, 5 and l0 days after treatment were observed. Results At the time points of 1, 5 and 10 days, the levels of cTnI of the control group did not change obviously. In the treatment group, the levels of cTnI on 5 days and 10 days were more descended than the level on 1 day obviously. The levels of cTnI were more decreased in the treatment group than those in the control group significantly （5 days： （0.83 ±0.60） μg/L vs. （1.50±1.48）μg/L, 10 days： （0. 61±0. 52）μg/L vs. （1.26±1.23） /lg/L, both P〈0. 05]. The levels of eTnI of the 36 survival patients were lowered more than those of the 19 dead patients markedly （5 days： （0.67± 0.49）μg/L vs. （1.61±1. 40） μg/L, 10 days： （0. 52±0. 45） μg/L vs. （1.32±1.17）μg/L, both P〈0. 05]. No statistic differences were found in two groups with the myocardial depression incidence and the ratio of the mitral annular diastole （E） and late diastole （A） inflow velocities （E/A） before the treatment. After 2-week therapy, the E/A was higher in treatment group than that in control group （1.4±0. 3 vs. 1.1±0. 2）, and the recovery time of cardiac depression was shorter in the treatment group than that of the control group [the regional wall motion recovery time： （7.0± 0. 6） days vs. （11.0± 0. 8） days, the left ventricular diastolic function recovery time： （4.0±0.5） days vs. （8.0±0.8） days, P〈0.05 or P〈0.01]. Conclusion Radix astragali injection has relatively strong protective effect on injured myocardium of severe sepsis patients and can resume the depressed cardiac function ahead of the time necessary for the control group.