加味破格救心汤联合针刺治疗脓毒症心肌病(心肾阳虚证)的临床研究

Clinical Study of Modified Poge Jiuxin Decoction Combined with Acupuncture in the Treatment of Septic Cardiomyopathy(Heart-Kidney Yang Deficiency Syndrome)

目的探究加味破格救心汤联合针刺对脓毒症心肌病(SIC)的影响及其可能的作用机制。方法研究对象为2022年3月至2023年9月收入成都市第一人民医院重症医学科(ICU)的108例脓毒症心肌病患者。按随机数字表法分为对照组与治疗组各54例。两组患者均予以脓毒症西医常规治疗,在此基础上,治疗组加用加味破格救心汤,每日1剂,早中晚各100 mL分服;同时针刺双侧足三里、关元、内关,每日针刺2次,两组均连续治疗7 d。于治疗前后检测患者C反应蛋白(CRP)、降钙素原(PCT)、肌钙蛋白(I cTnI)、N末端脑钠利肽前体(NT-proBNP)、血乳酸水平(Lac)等指标;计算急性生理与慢性健康评分Ⅱ(APACHEⅡ评分)、序贯器官功能衰竭评分(SOFA评分);超声心动图测算左心室射血分数(LVEF)、左室短轴缩短率(LVFS)及二尖瓣舒张早期与晚期血流峰值流速比值(E/A);同时记录心率(HR)、平均动脉压(MAP)、机械通气时间、使用血管活性药物时间、ICU住院时间、多器官功能障碍综合征(MODS)发生率及28 d病死率。结果两组治疗后炎症指标、心功能指标及血流动力学均较治疗前明显改善,且治疗组各项指标改善程度均优于对照组,差异均有统计学意义(均P<0.05);两组治疗后APACHEⅡ和SOFA评分均较前明显下降,且治疗组下降更为明显;治疗组使用血管活性药物时间、ICU住院时间较对照组明显缩短,MODS发生率和28 d病死率虽较对照组有所降低,但差异均无统计学意义(均P>0.05)。结论加味破格救心汤联合针刺可改善SIC患者的预后,其机制可能与抑制炎症反应,改善心功能有关。

Objective:To observe the effects of Modified Poge Jiuxin Decoction combined with acupuncture in the treatment of septic cardiomyopathy(SIC),and to explore its possible mechanism.Methods:Totally 108 pa⁃tients with SIC admitted to the department of Intensive Care Unit(ICU)of Chengdu First People′s Hospital from March 2022 to September 2023 were enrolled.The patients were divided into control group and treatment group ac⁃cording to random number table method,with 54 cases in each group.Patients in both groups received basic treat⁃ment for SIC.On this basis,the treatment group was administrated with modified Poge Jiuxin Decoction,one dose a day,100 mL in three meals a day.Acupuncture at bilateral Zusanli,Guanyuan and Neiguan points,twice a day.Both groups were treated for 7 days.C-reactive protein(CRP),procalcitonin(PCT),cardiac tropomin I(cTnI),ami⁃no-terminal brain natriuretic peptide precursor(NT-proBNP)and Lactic acid(Lac)were measured before and af⁃ter treatment.Acute Physiologic Assessment and Chronic Health EvaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)were calculated.The left ventricular ejection fraction(LVEF),fractional shortening of short axis of left ventricle(LVFS)and early and late mitral orifice diastolic peak flow velocity rate(E/A)were mea⁃sured by echocardiography.The heart rate(HR),mean arterial pressure(MAP),mechanical ventilation time,vasoac⁃tive drug use time,ICU stay time,incidence of multiple organ dysfunction syndrome(MODS)and 28 day mortality were recorded.Results:The indexes of inflammation,cardiac function and hemodynamics in the two groups were significantly improved after treatment.The improvement of various indexes in the treatment group were better than those in the control group,and the differences were statistically significantly(all P<0.05).After treatment,the APACHEⅡand SOFA scores in the two groups decreased significantly compared with those before treatment,and the decrease in the treatment group were more obvious than those in the control group.The vasoactive drug use time and ICU stay time were shortened in the treatment group than those in the control group.The incidence of MODS and the 28-day mortality were lower than those of the control group,but there were no statistical difference(both P>0.05).Conclusion:Poge Jiuxin Decoction combined with acupuncture can effectively improve the prog⁃nosis of patients with SIC,and its mechanism may be related to inhibition of inflammatory reaction and improve⁃ment of cardiac function.