左卡尼汀对脓毒症心肌损伤的保护作用

The protective effect of L-carnitine in sepsis patients with cardiac injury

目的:观察左卡尼汀在脓毒症合并心肌损伤患者中的保护作用。方法:将29例严重脓毒症患者分为治疗组(15例)和对照组(14例)。治疗组在综合治疗基础上加左卡尼汀治疗,对照组采用抗感染等综合治疗措施。在研究开始前及研究d3、d7抽血检测心肌肌钙蛋白I(CTn I)、N末端脑钠肽前体(NT-pro BNP),比较两组ICU住院死亡率。结果:1治疗前CTn I水平:治疗组(3.24±2.8)ng/ml,对照组(2.48±1.69)ng/ml;NT-pro BNP水平:治疗组(13711.93±6260.07)pg/ml,对照组(11790.43±8879.37)pg/ml。两组间CTn I及NT-pro BNP均较正常值升高,组间比较差异均无统计学意义(P>0.05)。2治疗d3 CTn I水平:治疗组(1.47±1.14)ng/ml,对照组(1.4±1.01)ng/ml;NT-pro BNP水平:治疗组(12194.73±7515.39)pg/ml,对照组(17202.29±7325.23)pg/ml。两组CTn I水平均有下降,对照NT-pro BNP水平升高,但CTn I及NT-pro BNP组间比较差异均无统计学意义(P>0.05)。3治疗d7 CTn I水平:治疗组(0.61±0.78)ng/ml,对照组(1.90±1.90)ng/ml;NT-pro BNP水平:治疗组(7413.47±6277.00)pg/ml,对照组(10958.57±6651.45)pg/ml。两组CTn I及NTpro BNP水平均有下降,治疗组的CTn I及NT-pro BNP水平均较对照组下降明显,组间比较CTn I差异有统计学意义(P<0.05),NTpro BNP差异无统计学意义(P>0.05)。4死亡率:两组均有3例死亡,ICU住院死亡率分别为20.00%VS 21.43%,死亡率差异无统计学意义(P>0.05)。结论:左卡尼汀能够减轻脓毒症患者的心肌损伤,改善心功能,具有心肌保护作用。

Objective：To evaluate the protective effect of L-carnitine in the sepsis patients with Myocardial injury.Methods：Retrospective analyse the levels of serum cardiac troponin I（CTnI）and N-terminal pro-B-type natriuretic peptide（NT-proBNP） in sepsis patients with Myocardial injury from 2013 Nov to 2014 Dec at EICU.29 patients divided into treatment group and control group.The control group was given routine therapy; the treatment group was given routine therapy and L-carnitine. CTnI and NT-proBNP was detected before treatment、3th and 7th days after treatment.Results：A significant difference was noted in CTnI between the two groups after therapy 7 days （P＜0.05）.There were no statistically significant difference in NT-proBNP and mortality rate.Conclusion：L-carnitine can reduce the myocardial injury in patients with sepsis,impove heart function.