【摘要】：[目的]膿毒癥心肌抑制的患者,在常規(guī)抗膿毒癥及針對心肌損傷治療的基礎(chǔ)上加用心脈隆注射液,觀察相關(guān)指標(biāo)的變化情況,評價(jià)臨床療效,評價(jià)心脈隆注射液用藥的有效性和安全性,為臨床早期應(yīng)用心脈隆治療膿毒癥心肌抑制提供理論依據(jù)。[方法]從2016年3月至2017年3月,篩選就診于昆明醫(yī)科大學(xué)第一附屬醫(yī)院急診ICU內(nèi)的,入院后經(jīng)診斷為膿毒癥的患者122例,經(jīng)積極液體復(fù)蘇后,符合膿毒癥心肌抑制標(biāo)準(zhǔn)67例,依據(jù)相關(guān)納入、排除、脫落標(biāo)準(zhǔn),36例患者納入這項(xiàng)臨床觀察研究中。按照入科先后順序及隨機(jī)數(shù)字表法分為實(shí)驗(yàn)組(心脈隆組)(n=17)和對照組(n=19),其中女性15例,男性21例,年齡位于23-76之間。兩組患者均予常規(guī)抗感染、液體復(fù)蘇,改善心功能等治療,均予深靜脈穿刺置入PICCO導(dǎo)管連接PICCO監(jiān)測儀進(jìn)行監(jiān)測,實(shí)驗(yàn)組在此基礎(chǔ)上加用心脈隆注射液5mg/kg+0.9%氯化鈉注射液200ml靜脈滴注,每日2次,連續(xù)使用5天;對照組加入0.9%氯化鈉注射液200ml靜脈滴注,每日2次,連續(xù)使用5天。分別于治療開始前、開始后24h、72h、120h抽取兩組患者外周靜脈血,檢測肌鈣蛋白I、B型腦利鈉尿肽值,使用多普勒超聲心動(dòng)圖監(jiān)測心臟指標(biāo),記錄血流動(dòng)力學(xué)相關(guān)指標(biāo);于治療前、治療120h抽取外周靜脈血檢測肝腎功能,記錄心率、平均動(dòng)脈壓情況并進(jìn)行統(tǒng)計(jì)、分析。實(shí)驗(yàn)數(shù)據(jù)采用spss 19.0統(tǒng)計(jì)學(xué)軟件包結(jié)合相關(guān)專業(yè)進(jìn)行統(tǒng)計(jì)學(xué)分析。[結(jié)果]1、經(jīng)兩獨(dú)立樣本t檢驗(yàn),實(shí)驗(yàn)組和對照組患者年齡、身高、APECHEII評分差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)X2檢驗(yàn)兩組患者性別、疾病種類、血液進(jìn)化差異均無統(tǒng)計(jì)學(xué)意義(P0.05),基線具有可比性。2、有效性指標(biāo):經(jīng)重復(fù)資料方差分析,BNP、肌鈣蛋白I實(shí)驗(yàn)組和對照組主體間、主體內(nèi)效應(yīng)的檢驗(yàn)差異均有統(tǒng)計(jì)學(xué)意義(P0.05);左室射血分?jǐn)?shù)、二尖瓣血流頻譜E/A峰、E峰減速時(shí)間、三尖瓣環(huán)收縮期偏移幅度實(shí)驗(yàn)組和對照組主體間、主體內(nèi)效應(yīng)的檢驗(yàn)差異均有統(tǒng)計(jì)學(xué)意義(P0.05),左室舒張末內(nèi)經(jīng)、左室收縮末內(nèi)經(jīng)實(shí)驗(yàn)組和對照組主體間、主體內(nèi)效應(yīng)的檢驗(yàn)差異均無統(tǒng)計(jì)學(xué)意義(P0.05);每博量指數(shù)、外周血管阻力指數(shù)、心功能指數(shù)實(shí)驗(yàn)組和對照組主體間、主體內(nèi)效應(yīng)的檢驗(yàn)差異均有統(tǒng)計(jì)學(xué)意義(P0.05),全心舒張末容積指數(shù)實(shí)驗(yàn)組和對照組主體間效應(yīng)的檢驗(yàn)差異無統(tǒng)計(jì)學(xué)意義(P0.05),主體內(nèi)效應(yīng)的檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、安全性指標(biāo):經(jīng)兩獨(dú)立樣本t檢驗(yàn),兩組患者治療前、后肝腎功能、心率、平均動(dòng)脈壓均無統(tǒng)計(jì)學(xué)意義(P0.05)。4、預(yù)后相關(guān)指標(biāo):經(jīng)兩獨(dú)立樣本t檢驗(yàn):兩組患者機(jī)械通氣時(shí)間、住ICU天數(shù)、多巴酚丁胺用量指標(biāo)差異有統(tǒng)計(jì)學(xué)意義(P0.05),住院全因死亡率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。5、經(jīng)直接記錄,實(shí)驗(yàn)組出1例心動(dòng)過速,余無其他不良反應(yīng)。[結(jié)論]1、心脈隆注射液可降低膿毒癥心肌抑制患者BNP、cTnl值,提高心臟收縮、舒張功能,有一定的改善心肌損傷作用。2、心脈隆注射液對膿毒癥心肌抑制患者肝腎功能、生命征無影響,無明顯不良反應(yīng),可作為治療膿毒癥心肌抑制的有益補(bǔ)充。
[Abstract]:[Objective] To observe the clinical efficacy and evaluate the efficacy and safety of intravenous injection in patients with sepsis and myocardial injury. To provide a theoretical basis for early clinical application of cardiac pulse therapy in the treatment of sepsis myocardium.[Methods] From March 2016 to March 2017, 122 patients with sepsis diagnosed as sepsis were screened in the emergency ICU of the First Affiliated Hospital of Kunming Medical University. After the positive liquid resuscitation, 67 cases of sepsis myocardial inhibition standard were met. According to relevant inclusion and exclusion, The dropout criteria, 36 patients were included in this clinical observation study. There were 15 males and 21 females in the experimental group (n = 17) and the control group (n = 19). Two groups of patients were treated with routine anti-infection, liquid resuscitation, cardiac function improvement and so on. The PICCO monitor was connected to the PICCO monitor for monitoring by deep vein puncture. The experimental group was treated with 5 mg/ kg + 0.9% sodium chloride injection by intravenous injection, twice daily. Five days were used continuously; 0. 9% sodium chloride injection was added to the control group for intravenous drip, twice daily for 5 days. Two groups of peripheral venous blood were extracted at 24h, 72h and 120h respectively before the start of treatment, and the values of troponin I and Btype brain natriuretic peptide were detected, cardiac index was monitored by Doppler echocardiography, and hemodynamic parameters were recorded; before treatment, Treatment 120h extracts peripheral venous blood to detect liver and kidney function, record heart rate, mean arterial pressure, and conduct statistics and analysis. Experimental data were analyzed by SPSS 19. 0 statistical software package in combination with related majors.[Results] 1. The differences of age, height and APECHEII score of the experimental group and the control group were not statistically significant (P0.05). After X2 test, there was no significant difference in sex, disease and blood evolution in the two groups (P0.05), and the baseline was comparable. There were significant differences in the main body effect (P 0.05), the left ventricular ejection fraction, the mitral valve blood flow spectrum E/ A peak, the E peak deceleration time, the systolic bias amplitude of the tricuspid annulus and the main body of the control group, and the difference in the main body effect was statistically significant (P0.05). There was no significant difference between the experimental group and the control group between the experimental group and the control group (P0.05). There was no significant difference in the main body effect (P0.05). The difference of the effect between the whole cardiac diastolic volume index and the control group was not statistically significant (P0.05), and the difference of the main body effect was statistically significant (P0.05). After two independent samples t test, there was no significant difference in the function of liver and kidney function, heart rate and mean arterial pressure (P0.05). The difference of dosage of dobutamine was statistically significant (P <0.05), and the difference in hospital total mortality was not statistically significant (P0.05).[Conclusion] 1. Xinmai injection can reduce BNP and cTnl value in patients with sepsis, improve cardiac systolic and diastolic function, and have certain effect on myocardial injury. has no obvious adverse reaction, and can be used as a beneficial supplement for treating the myocardial inhibition of sepsis.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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