芪参活血颗粒在治疗脓毒症合并心肌损伤中的作用

Effects of Qishenhuoxue granule in sepsis combined with myocardial injury

目的研究芪参活血颗粒对脓毒症合并心肌损伤患者心肌保护作用的机制。方法选择本院2015年至2017年间收治的脓毒症合并心肌损伤患者63例,采用随机数字表法分为对照组(33例,常规治疗)和观察组(30例,常规治疗基础上每日加用芪参活血颗粒治疗),治疗周期为1周。患者入选即刻、治疗后第7天采血行血常规、生化、血气、肌钙蛋白T(TNT)、N端脑钠肽前体(NT-proBNP)检查以及血压、脉搏、超声心动图检查;放射免疫法检测血管紧张素Ⅱ(Ang-Ⅱ)水平;ELISA法检测血栓烷A2(TXA2)、前列环素I2(PGI2)、内皮素-1(ET-1)等细胞因子水平,分析比较两组患者各项细胞因子变化、心功能变化及28 d死亡率。结果治疗后第7天,观察组及对照组患者NT-proBNP,TNT较第1天均有明显下降(P<0.05),射血分数(EF)有所提高(P>0.05),提示心功能好转,但观察组与对照组在相同时间点比较差异无统计学意义(P>0.05);治疗后第7天,观察组Ang-Ⅱ、ET-1水平较对照组明显减低,差异有统计学意义(P<0.05)。但观察组与对照组心功能指标及28 d死亡率比较,差异无统计学意义(P>0.05)。结论芪参活血颗粒辅助治疗可明显降低脓毒症合并心肌损伤患者的Ang-Ⅱ及ET-1水平,但在改善心肌损伤方面的作用需进一步研究。

Objective To research the effect of Qishenghuoxue granules in the treatment of sepsis combined with myocardial injury.Methods A total of 63 patients with sepsis combined with myocardial injury were randomly divided into two groups:33 cases in control group(conventional therapy for 7 d)and 30 cases in observation group(Qishenhuoxue granule for 7 d).Thromboxane A2(TXA2),prostaglandin I2(PGI2),endothelin 1(ET-1)and other cytokines were detected by enzyme-linked immunosorbent assay(ELISA).At the same time blood pressure,pulse,echocardiography were recorded.The mortality rate at the 28th day and the above values were statistically analyzed.Results On the 7th day after the intervention of Qishenhuoxue granule,N-terminal pro-brain natriuretic peptid(NT-proBNP)and troponin T(TNT)in the observation group and the control group were significantly lower than those on the 1st day,but there was no significant difference between the two groups at the same time point(P>0.05);On the 7th day after the intervention of Qishenhuoxue granule,the levels of angiotensinⅡ(Ang-Ⅱ)and ET-1 in the observation group were significantly lower than those in the control group(P<0.01),but there was no significant difference between the two groups in cardiac function index and 28 day mortality.Conclusions The Chinese herbal preparation Qishenhuoxue granule could reduce the blood levels of Ang-Ⅱand ET-1,but its effect on improving myocardial injury is still worthy of further study.