破格救心汤加减治疗脓毒症心肌病的临床疗效观察

Observation on the clinical efficacy of modified Poge Jiuxin Decoction in the treatment of septic cardiomyopathy

目的探讨破格救心汤加减治疗脓毒症心肌病的临床疗效。方法80例脓毒症心肌病患者,按照随机对照单盲模拟分为对照组和治疗组,各40例。对照组采用常规西医治疗,治疗组在对照组基础上增加破格救心汤加减治疗。比较两组左心室射血分数,心肌损害指标[B型利钠肽前体(pro-BNP)、超敏肌钙蛋白Ⅰ]及生化指标(白细胞计数、C反应蛋白),呼吸机辅助时间,去甲肾上腺素用量,入住重症监护室(ICU)时间及住院时间,死亡情况。结果治疗前,两组左心室射血分数、pro-BNP、超敏肌钙蛋白Ⅰ、白细胞计数及C反应蛋白比较,差异无统计学意义(P>0.05);治疗5 d后,治疗组左心室射血分数(58.25±6.03)%显著高于对照组的(52.02±6.13)%,pro-BNP(113.45±20.17)pg/ml、超敏肌钙蛋白I(0.35±0.12)ng/ml、白细胞计数(5.68±1.12)×10^(9)/L、C反应蛋白(7.24±1.56)mg/L均显著低于对照组的(198.42±12.53)pg/ml、(0.79±0.14)ng/ml、(7.75±2.67)×10^(9)/L、(10.05±1.29)mg/L,差异具有统计学意义(P<0.05)。治疗组呼吸机辅助时间(3.11±1.69)d、入住ICU时间(5.02±1.76)d、住院时间(15.56±4.26)d均显著短于对照组的(5.36±1.68)、(7.11±1.98)、(22.02±4.76)d,去甲肾上腺素用量(132.75±8.96)mg显著少于对照组的(173.25±9.53)mg,差异有统计学意义(P<0.05)。治疗组30、90 d死亡率与对照组比较,差异无统计学意义(P>0.05)。结论应用破格救心汤加减治疗脓毒症心肌病,可有效改善患者心功能,缩短患者康复进程,提升患者康复效率,临床应用价值较高。

Objective To discuss the clinical efficacy of modified Poge Jiuxin Decoction in the treatment of septic cardiomyopathy.Methods A total of 80 patients with septic cardiomyopathy were divided into a control group and a treatment group according to randomized control single blind simulation,with 40 cases in each group.The control group was treated with conventional Western medicine,and the treatment group was treated with modified Poge Jiuxin Decoction on the basis of the control group.Both groups were compared in terms of left ventricular ejection fraction,myocardial damage indexes[N-terminal pro-Btype natriuretic peptide(pro-BNP),hypersensitive troponin I],biochemical indexes(white blood cell count,C-reactive protein),mechanical ventilation time,noadrenaline dosage,length of intensive care unit(ICU)stay and hospital stay,and mortality.Results Before treatment,there was no statistically significant difference in left ventricular ejection fraction,pro-BNP,hypersensitive troponin I,white blood cell count and C-reactive protein between the two groups(P>0.05).After 5 d of treatment,the left ventricular ejection fraction of(58.25±6.03)%in the treatment group was significantly higher than that of(52.02±6.13)%in the control group;the treatment group had pro-BNP of(113.45±20.17)pg/ml,hypersensitive troponin I of(0.35±0.12)ng/ml,white blood cell count of(5.68±1.12)×10^(9)/L and C-reactive protein of(7.24±1.56)mg/L,which were significantly lower than those of(198.42±12.53)pg/ml,(0.79±0.14)ng/ml,(7.75±2.67)×10^(9)/L and(10.05±1.29)mg/L in the control group;the differences were statistically significant(P<0.05).In the treatment group,the mechanical ventilation time was(3.11±1.69)d,the length of ICU stay was(5.02±1.76)d and the hospital stay was(15.56±4.26)d,which were significantly shorter than those of(5.36±1.68),(7.11±1.98)and(22.02±4.76)d in the control group;the dosage of norepinephrine of(132.75±8.96)mg in the treatment group was significantly lower than that of(173.25±9.53)mg in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in 30 and 90-d mortality between the treatment group and the control group(P>0.05).Conclusion Modified Poge Jiuxin Decoction for the treatment of septic cardiomyopathy can effectively improve the cardiac function of patients,shorten the rehabilitation process of patients,improve the rehabilitation efficiency of patients,and has high clinical application value.