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刘炳炜.川芎嗪对脓毒症心肌损害患者保护作用的研究[J].浙江中西医结合杂志,2018,28(8):
川芎嗪对脓毒症心肌损害患者保护作用的研究
Protective effects of Tetramethylpyrazine on myocardial injury in patients with sepsis
投稿时间:2017-07-05  修订日期:2018-06-06
DOI:
中文关键词:  川芎嗪  脓毒症心肌损害  保护
英文关键词:
基金项目:浙江省中医药科研基金计划资助项目 编号:2015ZB078 TNF-α在脓毒症心肌损伤中的作用及川芎嗪对脓毒症心功能的影响
作者单位E-mail
刘炳炜 杭州市第一人民医院 liuliu8012700@aliyun.com 
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中文摘要:
      【摘要】 目的 探讨川芎嗪注射液对脓毒症心肌损害患者的保护作用。方法 选择我科收治的脓毒症心肌损害病人50例,随机分为常规治疗组和常规治疗+川芎嗪(TMP)组,每组各25例,两组于治疗前及治疗后1、5、10天分别检测血浆B型脑钠肽前体(Pro-BNP)浓度、 肿瘤坏死因子(TNF-α)的血清浓度、心肌肌钙蛋白I(TNI)水平;并行脉搏指示连续心排血量(PICCO)监测,测量心指数(CI)、左心室收缩力指数(dpmax),测量3次,取平均值;并监测乳酸水平的变化。采用Pearson相关分析TNF-α与CI的相关性。结果 两组患者治疗后Pro-BNP、TNF-α、TNI均下降,但常规治疗+川芎嗪(TMP)组下降得更快,更明显, 常规治疗+川芎嗪(TMP)组治疗后第一天Pro-BNP(1225.32?305.66)pg/ml与治疗前比较差异就有统计学意义,P<0.05,治疗后第5天Pro-BNP与常规治疗组同时间比较P<0.01;常规治疗+川芎嗪(TMP)组治疗后第5天TNI与治疗前比较就有统计学差异;常规治疗+川芎嗪(TMP)组治疗后第一天TNF-α(487.88?46.38)pg/ml与治疗前比较差异就有统计学意义,P<0.05,治疗后第5天TNF-α与常规治疗组同时间比较P<0.01;CI、dpmax、乳酸常规治疗+川芎嗪(TMP)组较常规治疗组也明显改善,常规治疗+川芎嗪(TMP)组治疗5天CI达到(3.13?0.18) L/min/m2,与常规治疗组同时间比较(2.79?0.17)L/min/m2差异显著,P<0.01;dpmax及乳酸在常规治疗+川芎嗪(TMP)组治疗后5天分别为(1016.40?26.19)mmHg/s、(1.83?0.21)mmol/L,与常规治疗组同时间比较P<0.01;TNF-α与CI呈负相关(-r=0.48, P<0.05)。结论 川芎嗪对脓毒症心肌损害患者的心功能有保护作用,其机制可能与降低TNF-α浓度有关,改善心功能。
英文摘要:
      【Abstract】 Objective:To explore the protective effect of Tetramethylpyrazine( TMP)on myocardial injury in patients with sepsis.Methods: 50 patients with sepsis myocardial damage were randomly divided into conventional treatment group ( n=25)and conventional treatment plus TMP group( n=25). Plasma B-type pro-brain natriuretic peptide (Pro-BNP), tumor necrosis factor-α (TNF-α), serum cardiac troponin I (TNI) were measured Before treatment and after treatment 1,5,10 days; the cardiac index (CI) and left ventricular contractile force index (dpmax) were measured by continuous pulse cardiac output (PICCO), measured three times and averaged. The changes of lactate levels were monitored. The correlation between TNF-α and CI was analyzed by Pearson correlation.Results: After treatment, the levels of Pro-BNP, TNF-α and TNI were decreased in both groups, but the treatment group and TMP group decreased more quickly and more obviously;In conventional treatment plus TMP group, Pro-BNP (1225.32 ± 305.66) pg / ml on the first day after treatment was statistically significant compared with that before treatment P <0.05, Pro-BNP was compared with the conventional treatment group at the same time on 5th day after treatment P <0.01; Conventional treatment plus TMP group on the fifth day after treatment TNI compared with before treatment there was a statistical difference; The difference of TNF-α (487.88 ± 46.38) pg / ml between the conventional treatment and the conventional treatment plus TMP group was statistically significant (P <0.05),5 days after treatment, TNF-α was compared with the conventional treatment group at the same time P <0.01;CI, dpmax, lactic acid treatment + TMP group than the conventional treatment group was significantly improved. In conventional treatment plus TMP group,5 days after treatment CI reached (3.13 ± 0.18) L / min / m2, compared with the conventional treatment group (2.79 ± 0.17) L / min / m2, the difference was significant (P <0.01); In conventional treatment plus TMP group,5 days after treatment dpmax and lactic acid were (1016.40 ± 26.19) mmHg / s, (1.83 ± 0.21) mmol / L, respectively, compared with the conventional treatment group P <0.01;TNF-α was negatively correlated with CI (-r = 0.48, P <0.05).Conclusion: Tetramethylpyrazine has protective effect on cardiac function in patients with sepsis myocardial damage. The mechanism may be related to the decrease of TNF-α concentration and the improvement of cardiac function.
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