参附注射液对脓毒症休克患者心脏舒张功能的影响及疗效观察

Effect of Shenfu injection on cardiac diastolic function in patients with septic shock and its therapeutic effect

目的观察参附注射液对脓毒症休克患者心脏舒张功能的影响及疗效。方法将60例脓毒症休克患者按随机数字表法分为观察组和对照组各30例。两组均给予常规集束化治疗(液体复苏、抗感染、氧疗等)。观察组在常规治疗基础上给予参附注射液100 ml加入5%葡萄糖100 ml中静滴,1次/d。检测两组治疗前及治疗后第7天血清N端脑钠肽前体(NT-proBNP)及心肌肌钙蛋白T(cTnT)水平;治疗前及治疗后第7天分别行超声心动图测定左心室舒张末内径(LVEDD)、左心室舒张末容积(LVEDV)、二尖瓣舒张早期血流峰速(E)及二尖瓣环舒张早期运动速度(E′),并计算E/E′比值,同时记录患者入院第1天和治疗第7天最高急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯性器官衰竭评分(SOFA)、机械通气时间及ICU入住时间。结果经治疗1周,观察组NT-proBNP、cTnT、LVEDD、LVEDV、E/E′比值低于对照组(P<0.05);治疗后观察组APACHEⅡ评分和SOFA评分低于对照组(P<0.05)。观察组机械通气时间及ICU入住时长短于对照组(P均<0.05)。结论参附注射液可以改善脓毒症休克患者心脏舒张功能,减轻多器官功能障碍综合征(MODS)的严重程度,提高疗效。

Objective To observe the effect of Shenfu injection on cardiac diastolic function in patients with septic shock and its therapeutic effect.Methods Sixty patients with septic shock were randomly divided into observation group and control group according to the random number table method,with 30 cases in each group.Both groups were given standard conventional cluster therapy(fluid resuscitation,anti-infection,oxygen therapy,etc.).On the basis of this conventional treatment,the observation group was given Shenfu injection 100 ml added with 5%glucose 100 ml for intravenous drip,once a day.The serum levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and cardiac troponin T(cTnT)were detected before and 7 days after treatment in the two groups.Left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV),peak velocity of early mitral valve dilation(E)and early diastolic velocity of mitral annulus(E′)were measured by echocardiography before and 7 days after treatment,and E/E′was calculated.At the same time,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score and Sequential Organ Failure Assessment(SOFA)score were recorded on the first day of admission and on the seventh day of treatment.The duration of mechanical ventilation and the length of Intensive Care Unit(ICU)stay were recorded.Results After 1 week of treatment,the levels of NT-proBNP,cTnT,LVEDD,LVEDV and E/E′in the observation group were significantly lower than those in the control group(P<0.05).The APACHEⅡscores and the SOFA scores in the observation group were significantly lower than those in the control group after treatment(P<0.05).The duration of mechanical ventilation and the length of ICU stay in the observation group were significantly shorter than those in the control group(P<0.05).Conclusion Shenfu injection can improve the cardiac diastolic function of septic shock patients,reduce the severity of multiple organ dysfunction syndrome(MODS)and improve the therapeutic effect.