左西孟旦辅助HVHF治疗脓毒症继发心肌损伤的临床研究

Clinical study of levosimendan-assisted HVHF in the treatment of myocardial injury secondary to sepsis

目的探讨左西孟旦辅助高容量血液滤过(HVHF)治疗脓毒症继发心肌损伤的临床疗效。方法选取我院2018年1月至2020年6月收治的脓毒症继发心肌损伤患者共76例,随机分为对照组和试验组,每组各38例。对照组采用单纯HVHF治疗,试验组在对照组基础上加用左西孟旦辅助治疗。比较两组治疗前后的凝血功能、血管内皮功能、炎性细胞因子、氧化应激指标、凋亡相关因子、心肌损伤指标。结果试验组治疗后PT、TT、APTT及ET-1水平均显著低于对照组、治疗前(P<0.05);试验组治疗后NO水平显著高于对照组、治疗前(P<0.05)。试验组治疗后CRP、IL-8及TNF-α水平均显著低于对照组、治疗前(P<0.05);试验组治疗后SOD和GSH-PX水平均显著高于对照组、治疗前(P<0.05);试验组治疗后MDA、AOPP水平均显著低于对照组、治疗前(P<0.05)。试验组治疗后Caspase-3和Caspase-8水平均显著低于对照组、治疗前(P<0.05);试验组治疗后sFasl和BCL-2水平均显著高于对照组、治疗前(P<0.05)。试验组治疗后cTnI、CK、CK-MB均显著低于对照组、治疗前(P<0.05)。结论左西孟旦辅助HVHF治疗脓毒症继发心肌损伤可有效促进凝血功能恢复,保护血管内皮功能,抑制机体炎症反应,并有助于减轻氧化应激损伤及细胞凋亡损伤,从而减轻心肌损伤。

Objective To explore the clinical efficacy of levosimendan-assisted high-volume hemofiltration(HVHF)in the treatment of myocardial injury secondary to sepsis.Methods A total of 76 patients with myocardial injury secondary to sepsis admitted to our hospital from January 2018 to June 2020 were selected and randomly divided into two groups.Among them,38 cases in the control group were treated with HVHF alone,and 38 cases in the experimental group were treated with adjuvant levosimendan in addition to HVHF.The coagulation function,vascular endothelial function,inflammatory cytokines,oxidative stress indicators,apoptosis-related factors,and myocardial injury indicators before and after treatment were compared between the two groups.Results After treatment,the levels of PT,TT,APTT and ET-1 in the experimental group were significantly lower than those in the control group and before treatment(P<0.05);the NO level in the experimental group were significantly higher than that in the control group and before treatment(P<0.05).The levels of CRP,IL-8 and TNF-αafter treatment in the experimental group were significantly lower than those in the control group and before treatment(P<0.05);the levels of SOD and GSH-PX after treatment in the experimental group were significantly higher than those in the control group and before treatment(P<0.05).The MDA and AOPP levels of the experimental group after treatment were significantly lower than those of the control group and before treatment(P<0.05).The levels of Caspase-3 and Caspase-8 after treatment in the experimental group were significantly lower than those in the control group and before treatment(P<0.05);the levels of sFasl and BCL-2 after treatment in the experimental group were significantly higher than those in the control group and before treatment(P<0.05).The cTnI,CK and CK-MB of the experimental group after treatment were significantly lower than those of the control group and before treatment(P<0.05).Conclusion levosimendan-assisted HVHF in the treatment of myocardial injury secondary to sepsis can effectively promote the recovery of coagulation function,protect vascular endothelial function,inhibit the body′s inflammatory response,and help reduce oxidative stress damage and apoptosis damage,thereby reducing myocardial damage.