新四逆汤对脓毒症心肌顿抑患者无创血流动力学的影响

Noninvasive hemodynamical effect of xinsini decoction on sepsis-induced myocardial stunning in the patients

目的通过脓毒症心肌顿抑患者无创血流动力学检测,评价新四逆汤的临床疗效。方法将40例脓毒症心肌顿抑患者随机分为对照组和治疗组,每组20例。两组病例均给予抗感染、止咳化痰、补液、治疗原发病、预防并发症、加强营养支持等常规西医治疗,对照组加用中药新四逆汤安慰剂治疗,治疗组给予中药新四逆汤治疗。疗程为7 d。观察两组治疗前后心功能评级、无创血流动力学指标(HR、SV、ACI、VI、TFC、SVR)、超声射血分数(EF)变化情况。结果治疗组治疗后EF、SV、ACI、TFC与本组治疗前比较差异有统计学意义(P<0.01),治疗组治疗前后EF、SV、TFC差值与对照组比较差异有统计学意义(P<0.01,P<0.05)。结论脓毒症心肌顿抑属少阴病寒化证阴阳俱衰阶段,该阶段“阳气易复,阴液难补”,新四逆汤可有效提高心肌收缩力、增加每分输出量、减轻心脏负荷以纠正循环衰竭,该方可回阳救逆、益气固脱,护阴防血溢脉外,临床有很好的疗效。

Objective To evaluation the effect of xinsini decoction through noninvasive hemodynamical monitoring in the patients with sepsis-induced myocardial stunning.Methods A total of 40 patients with sepsis-induced myocardial stunning were randomized into a control group and a treatment group,20 cases in each one.The routine Western medicine treatment was provided in the two groups with anti-infection,stopping cough,resolving phlegm,rehydration,treatment of the primary disease and the prevention of complications,as well as strengthening nutrition support.Additionally,the xinsini decoction placebo was used in the control group and xinsini decoction in the treatment group.The duration of treatment was 7 days.Before and after treatment,the cardiac function rating,noninvasive hemodynamic indexes(HR,SV,ACI,VI,TFC and SVR)and ultrasonic ejection fraction(EF)were observed in the two groups.Results After treatment,the levels of EF,SV,SCI and TFC were different significantly as compared with those before treatment in the treatment group(P<0.01).The different values of EF,SV and TFC before and after treatment in the treatment group were different significantly as compared with those in the control group(P<0.01,P<0.05).Conclusion Sepsis-induced myocardial stunning is differentiated as the cold transformation syndrome of shaoyin disease at the declining stage of yin and yang.At this stage,both yang qi and yin fluid cannot be restored and supplemented.Xinsini decoction effectively improves myocardial contractility,increases output per minute and reduces cardiac load so as to correct circulation failure.Such formula acts on rescuing yang from collapse,benefiting qi for the collapse and protecting yin to prevent blood running outside vessel.The clinical effect is satisfactory.