清源养心汤对重症骨创伤所致脓毒症的心脏保护作用研究
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摘要
目的观察清源养心汤对重症骨创伤所致脓毒症患者的心脏保护作用。方法将78例重症骨创伤所致脓毒症患者随机分为2组。对照组39例予常规西医治疗;治疗组39例在对照组治疗基础上加清源养心汤治疗。2组均治疗7 d。比较2组治疗前后凝血功能指标血浆凝血酶原时间(PT)、纤维蛋白原(FIB)、部分活化凝血活酶时间(APTT)及血清D-二聚体(D-D)水平,心肌生化指标[血浆肌酸激酶同工酶(CK-MB)、高敏心肌肌钙蛋白T(hs-cTnT)、N末端脑利钠肽前体(NT-ProBNP)]及血清C反应蛋白(CRP)水平,心功能指标左室射血分数(LVEF)、舒张早期心室充盈速度最大值E峰/舒张晚期心室充盈速度最大值A峰(E/A)比值、左室舒张末期容积指数(LVEDVI)及左室收缩末期容积指数(LVESVI)变化情况。结果 2组治疗后PT、APTT均较本组治疗前缩短(P<0.05),FIB水平升高(P<0.05),D-D水平降低(P<0.05),且治疗组与对照组比较差异有统计学意义(P<0.05)。2组治疗后血浆CK-MB、hs-cTnT、NTProBNP及血清C-反应蛋白水平均较本组治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。治疗后治疗组LVEF、E/A比值均较本组治疗前升高(P<0.05),LVEDVI及LVESVI降低(P<0.05),且与对照组治疗后比较差异均有统计学意义(P<0.05);对照组治疗后E/A比值、LVEDVI及LVESVI均较本组治疗前明显改善(P<0.05)。结论清源养心汤对重症骨创伤所致脓毒症患者具有心脏保护作用。
Objective To observe the clinical effects of Qingyuan-Yangxin decoction on cardiac protection of severe bone trauma-induced sepsis. Methods 78 patients with severe bone trauma-induced sepsis were randomly divided into two groups. 39 cases in control groupwere treated by conventionalwesternmedicine. 39 cases in treatment groupwere treated by Qingyuan-Yangxin decoction on the basis of control group. After treatment for 7 days,blood coagulation function [ plasma prothrombin time( PT),fibrinogen( FIB),partial activated thromboplastin time( APTT) ] and serum DD dimer,cardiac biochemical index [plasma creatine kinase isoenzyme( CK-MB),high-sensitivity cardiac troponin T( hs-c Tn T),N-terminal brain natriuretic peptide precursor( NT-Pro BNP) ]and C-reactive protein,cardiac function index [ left ventricular ejection fraction( LVEF),maximum value of ventricular filling velocity at early diastolic velocity E peak/A peak( E/A) ratio,left ventricular end diastolic volume index( LVEDVI) and left ventricular end systolic volume index( LVESVI) ]were compared before and after treatment in two groups. Results After treatment,PT and APTT were lower in the two groups than before treatment( P < 0. 05),and FIB and D-dimer levels were decreased( P < 0. 05),and there was a significant difference between the treatment group and the control group after treatment( P < 0. 05). After treatment,the Plasma levels of CK-MB,hs-c Tn T,NT-Pro BNP and serum CRP in the two groups were lower than before treatment( P < 0. 05),and the treatment group was lower than the control group( P < 0. 05). After treatment,the LVEF and E/A ratios in the treatment group were higher than those before treatment( P < 0. 05),and LVEDVI and LVESVI were decreased( P <0. 05),and there was a significant difference between the treatment group and the control group after treatment( P <0. 05). After treatment,the E/A ratio,LVEDVI,and LVESVI in control group were significantly improved compared with those before treatment( P < 0. 05). Conclusion Qingyuan-Yangxin decoction has cardioprotective effect on patients with sepsis due to severe bone trauma.
Objective To observe the clinical effects of Qingyuan-Yangxin decoction on cardiac protection of severe bone trauma-induced sepsis. Methods 78 patients with severe bone trauma-induced sepsis were randomly divided into two groups. 39 cases in control groupwere treated by conventionalwesternmedicine. 39 cases in treatment groupwere treated by Qingyuan-Yangxin decoction on the basis of control group. After treatment for 7 days,blood coagulation function [ plasma prothrombin time( PT),fibrinogen( FIB),partial activated thromboplastin time( APTT) ] and serum DD dimer,cardiac biochemical index [plasma creatine kinase isoenzyme( CK-MB),high-sensitivity cardiac troponin T( hs-c Tn T),N-terminal brain natriuretic peptide precursor( NT-Pro BNP) ]and C-reactive protein,cardiac function index [ left ventricular ejection fraction( LVEF),maximum value of ventricular filling velocity at early diastolic velocity E peak/A peak( E/A) ratio,left ventricular end diastolic volume index( LVEDVI) and left ventricular end systolic volume index( LVESVI) ]were compared before and after treatment in two groups. Results After treatment,PT and APTT were lower in the two groups than before treatment( P < 0. 05),and FIB and D-dimer levels were decreased( P < 0. 05),and there was a significant difference between the treatment group and the control group after treatment( P < 0. 05). After treatment,the Plasma levels of CK-MB,hs-c Tn T,NT-Pro BNP and serum CRP in the two groups were lower than before treatment( P < 0. 05),and the treatment group was lower than the control group( P < 0. 05). After treatment,the LVEF and E/A ratios in the treatment group were higher than those before treatment( P < 0. 05),and LVEDVI and LVESVI were decreased( P <0. 05),and there was a significant difference between the treatment group and the control group after treatment( P <0. 05). After treatment,the E/A ratio,LVEDVI,and LVESVI in control group were significantly improved compared with those before treatment( P < 0. 05). Conclusion Qingyuan-Yangxin decoction has cardioprotective effect on patients with sepsis due to severe bone trauma.
引文
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[18]王红,张淑文,任爱民,等.重度脓毒症凝血功能紊乱与病情严重度及预后的关系[J].中华急诊医学杂志,2005,14(10):804-806.
[19]李曦,张丽宏,王晓晓,等.当归化学成分及药理作用研究进展[J].中药材,2013,36(6):1023-1028.
[20]林宏.金银花药理研究进展[J].江西中医学院学报,2009,21(6):82-84.
[21]王承娟,祝益民.黄芪及其有效成分对脓毒症心肌保护作用的研究进展[J].中国中西医结合急救杂志,2016,23(3):325-327.
[22]高天红.红花提取物活血化瘀作用及抗血栓作用机制的实验研究[D].太原:山西医科大学,2011.
[23]汪文颖,李金胜.赤芍与白芍的药理作用分析[J].中国实验方剂学杂志,2010,26(7):112-114.
[24]陈德昌,景炳文,杨兴易,等.大黄对创伤后危重病脓毒症患者的治疗作用[J].中华创伤杂志,2003,19(1):17-19.
[25]汤彦,申国璋,向小卫,等.大黄对全身炎症反应综合征患者凝血功能的影响[J].中国急救医学,2004,24(2):138.
[2]齐洪娜,张建军,何佳起,等.心型脂肪酸结合蛋白和N-末端脑钠肽前体在脓毒症心肌损伤中的临床研究[J].中国全科医学,2017,20(9):1042-1048.
[3]Jiang ZM,Yang QH,Zhu CQ.UCP2 in early diagnosis and prognosis of sepsis[J].European Review for Medical&Pharmacological Sciences,2017,21(3):549-553.
[4]陈如康,吴伟,梁艳,等.创伤脓毒症患者采用参麦注射液联合乌司他丁对脏器功能保护作用的临床研究[J].浙江创伤外科,2017,22(4):717-719.
[5]朱永,李娜,何振扬,等.腹部多发伤患者引流液可溶性髓样细胞触发受体检测对腹创伤脓毒症的诊断分析研究[J].中华医院感染学杂志,2016,26(8):1795-1797.
[6]Lee JH,Kim HY,Bae EH,et al.Biomarkers Predicting Survival of Sepsis Patients Treated with Continuous Renal Replacement Therapy[J].Chonnam Medical Journal,2017,53(1):64-68.
[7]王凤英,杨铁柱,明松林,等.清源生化汤对骨创伤后脓毒症患者的多脏器保护作用及机制研究[J].中国中西医结合杂志,2015,35(7):778-782.
[8]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华危重病急救医学,2015,27(6):401-426.
[9]高戈,冯吉吉,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505.
[10]Green S,Kong VY,Clarke DL,et al.The spectrum and outcome of surgical sepsis in Pietermaritzburg,South Africa[J].South African medical journal=Suid-Afrikaanse tydskrif vir geneeskunde,2017,107(2):134-136.
[11]Verdonk F,Blet A,Mebazaa A.The new sepsis definition:limitations and contribution to research and diagnosis of sepsis[J].Current Opinion in Anaesthesiology,2017,30(2):200-204.
[12]李良业.基于“气血相关”理论治疗严重骨创伤脓毒症患者凝血功能障碍及预后影响的回顾性研究[J].辽宁中医杂志,2014,41(8):1668-1670.
[13]邓彦俊,李振华,王国兴,等.心肌肌钙蛋白T与脓毒症心功能障碍相关性及预后的研究[J].临床和实验医学杂志,2017,16(10):954-958.
[14]刘炳炜,胡炜,胡伟航,等.TNF-α、Pro-BNP在脓毒症心功能障碍中的作用[J].中华全科医学,2017,15(10):1678-1680,1811.
[15]贺红霞,胡苏萍,黄毅.血浆NT-pro BNP水平对脓毒症合并心肌损伤的诊断价值[J].临床肺科杂志,2011,16(4):523-524.
[16]Bu X,Chen J,Wan Y,et al.Diagnostic Value of DDimer Combined with WBC Count,Neutrophil Percentage and CRP in Differentiating Between Simple and[J].Clinical Laboratory,2016,62(9):1675-1681.
[17]俞聪波,叶映月,华双益,等.急诊感染患者凝血障碍与脓毒血症的关系及参考评价[J].中华医院感染学杂志,2017,27(23):5308-5311.
[18]王红,张淑文,任爱民,等.重度脓毒症凝血功能紊乱与病情严重度及预后的关系[J].中华急诊医学杂志,2005,14(10):804-806.
[19]李曦,张丽宏,王晓晓,等.当归化学成分及药理作用研究进展[J].中药材,2013,36(6):1023-1028.
[20]林宏.金银花药理研究进展[J].江西中医学院学报,2009,21(6):82-84.
[21]王承娟,祝益民.黄芪及其有效成分对脓毒症心肌保护作用的研究进展[J].中国中西医结合急救杂志,2016,23(3):325-327.
[22]高天红.红花提取物活血化瘀作用及抗血栓作用机制的实验研究[D].太原:山西医科大学,2011.
[23]汪文颖,李金胜.赤芍与白芍的药理作用分析[J].中国实验方剂学杂志,2010,26(7):112-114.
[24]陈德昌,景炳文,杨兴易,等.大黄对创伤后危重病脓毒症患者的治疗作用[J].中华创伤杂志,2003,19(1):17-19.
[25]汤彦,申国璋,向小卫,等.大黄对全身炎症反应综合征患者凝血功能的影响[J].中国急救医学,2004,24(2):138.