脉搏指示连续心排血量测定监测回阳救逆汤对脓毒性心肌病的疗效观察

Clinical Study of Huiyang Jiuni Decoction in the Treatment of Sepsis-induced Cardiomyopathy by Using Pulse Indicator Continuous Cardiac Output Monitor

目的 通过脉搏指示连续心排血量测定(Picco)监测的心功能指标探讨中药回阳救逆汤对脓毒性心肌病患者的治疗效果。方法 脓毒性心肌病患者60例采用随机数字表法分为对照组与试验组各30例。两组患者均接受常规治疗及放置Picco导管监测心功能指标,试验组在对照组的基础上加用中药回阳救逆汤,疗程为7 d。治疗前后比较两组患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官功能衰竭(SOFA)评分、肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、B型脑钠肽(BNP)水平的变化,同时观察两组患者心脏指数(CI)、全心舒张末期容积指数(GEDVI)、胸腔内血容积指数(ITBVI)的变化。结果 两组患者治疗后APACHEⅡ评分、SOFA评分、cTnI、CK-MB、BNP水平均显著降低,CI、GEDVI、ITBVI均显著上升(P <0.05);与对照组比较,治疗后试验组APACHEⅡ评分、SOFA评分、cTnI、CK-MB、BNP水平改善更显著,CI、GEDVI、ITBVI水平提高更明显(P <0.05)。结论 通过Picco监测的心功能指标,提示脓毒性心肌病患者在常规治疗基础上结合回阳救逆汤能改善患者心肌损伤标志物水平及心脏功能,对心肌有一定的保护作用。

Objective:To investigate the clinical effect of Huiyang Jiuni Decoction in the treatment of sepsis-in-duced cardiomyopathy(SIC)by the index of cardiac function through pulse indicator continuous cardiac output(PICCO)monitor.Methods:A total of 60 patients with SIC admitted to the ICU of our hospital were divided into the observation group(n=30)and control group(n=30)according to the random number table method.The two groups were given conventional therapy and were placed the Picco catheter to monitor the index of cardiac func-tion.The observation group was treated with Huiyang Jiuni Decoction on the basis of the control group.The obser-vation period lasted 7 days.The level changes of acute physiology and chronic health evaluation I(APACHE I)and sequential organ failure assessment(SOFA)scores,cardiac troponin I(cTnl),brain natriuretic peptide(BNP)and Creatine Kinase Myocardial Band(CK-MB)levels were compared before and after treatment.At the same time,the cardiac function was monitored by Picco,and the changes of cardiac index(CI),global end diastolic vol-ume index(GEDVI),intrapleural blood volume index(ITBVI)were compared before and after treatment.Results:After treatment,the levels of cTnI,BNP,CK-MB and the scores of APACHE II and SOFA decreased in the two groups of patients,while CI,GEDVI and ITBVI which were monitored by Picco were improved in both groups,and the differences were statistically significant(P<0.05).The levels of cTnI,BNP,CK-MB and the scores of APACHE II and SOFA in the observation group were lower than those in the control group,while CI,GEDVI and ITBVI in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion:The index of cardiac function monitored by Picco suggests that on the basis of treatment with conventional therapy,Huiyang Jiuni Decoction has exact curative effect,and can im-proved the level of myocardial injury markers and cardiac function,and have a certain protective effect on myocar-dial injury.