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赖志珍.参附注射液对脓毒性休克低心排患者血流动力学和心肌损伤标志物的影响[J].浙江中西医结合杂志,2018,28(8):
参附注射液对脓毒性休克低心排患者血流动力学和心肌损伤标志物的影响
Effects of Shen-fu injection on systemic hemodynamics and markers of myocardial damage in patients with septic shock and low cardiac output
投稿时间:2017-08-10  修订日期:2018-07-04
DOI:
中文关键词:  参附注射液  脓毒性休克 低心排  血流动力学 心肌损伤
英文关键词:Shen-fu injection  septic shock  low cardiac output  systemic hemodynamics  myocardial damage
基金项目:浙江省中医药科学研究(No.2016ZA015)
作者单位E-mail
赖志珍 浙江省立同德医院 gkim12395@126.com 
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中文摘要:
      摘要 目的 探讨参附注射液对脓毒性休克低心排患者血流动力学及心肌损伤标志物的影响。方法 选择2014年6月至2016年6月确诊为脓毒性休克患者,将液体复苏后PiCCO监测心脏指数(CI)≤3.0 L·min-1·m-2的50例患者随机分为多巴酚丁胺组和参附组,每组25例。多巴酚丁胺组持续静脉注射5μg·kg-1·min-1多巴酚丁胺48 h;参附组在此基础上加用参附注射液100ml 静滴 Q12H连续2天。观察治疗前后两组血流动力学指标和心肌损伤标志物水平。结果 与多巴酚丁胺组比较,治疗后参附组每搏指数(SVI)、心脏指数(CI)、平均动脉压(MAP)增加(41.8±9.7 ml/m2比36.6±8.1 ml/m2, 2.8±0.6 L·min-1·m-2比2.5±0.4 L·min-1·m-2,73.5±6.2 mmHg比69.8.±5.2 mmHg,P均<0.05=)及血管外肺水指数(EVLWI)明显下降(8.9±2.4 ml/kg比6.5±2.0 ml/kg,P<0.05=);与多巴酚丁胺组比较,治疗后参附组降低人心型脂肪酸结合蛋白(h-FABP)、肌钙蛋白I(TNI)水平(11.5±2.6 ng/mL比13.1±2.9 ng/mL,0.20±0.08 μg/L比0.25±0.07 μg/L,P均<0.05);并且降低血乳酸水平(3.6±0.7mmol/L比4.0±0.7mmol/L,P<0.05)。但是,两组机械通气时间、住ICU时间、住院时间以及28天病死率比较,差异统计学意义(P均>0.05)。结论 参附注射液可增强脓毒性休克低心排患者的心脏收缩功能,提高平均动脉血压,降低血管外肺水,改善受损心肌细胞。
英文摘要:
      Effects of Shen-fu injection on systemic hemodynamics and markers of myocardial damage in patients with septic shock and low cardiac output LAI Zhizhen*,MENG Jianbiao,HU Mahong,XU Xiujuan,JI Chunlian,ZHANG Geng *Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China. Corresponding author: LAI Zhizhen, E-mail: gkim12395@126.com. Abstract Objective To investigate effects of Shen-fu injection on systemic hemodynamics and markers of myocardial damage in patients with septic shock and septic shock and low cardiac output .Methods Fifty patients who were treated including fluid resuscitation with septic shock were observed from June, 2014 to June 2016 , cardiac index (CI) evaluated by pulse indicator continuous cardiac output(PiCCO)was less than 3.0 L·min-1·m-2,who were randomized to receive 48h infusion of either dobutamine (5μg·kg-1·min-1 ,48h, n=25) (dobutamine group) or Shen-fu injection (add 100ml ivgtt q12h, 48h, n=25)( Shen-fu group). The hemodynamics were evaluated by PiCCO. The levels of troponin I(TNI), human heart-type fatty acid binding protein(h-FABP) and lactic acid before and after treatment were recorded and compared in the two group. Results Compared with dobutamine group, Shen-fu group increased stroke volume index (SVI), cardiac index (CI), and MAP(41.8±9.7 ml/m2 vs 36.6±8.1 ml/m2, 2.8±0.6 L·min-1·m-2 vs 2.5±0.4 L·min-1·m-2,73.5±6.2 mmHg vs 69.8.±5.2 mmHg, all P<0.05=) and decreased extravascular lung water index (EVLWI)( 8.9±2.4 ml/kg vs 6.5±2.0 ml/kg, P<0.05=. Shen-fu group also could decrease the serum levels of TNI and h-FABP (11.5±2.6 ng/mL vs 13.1±2.9 ng/mL,0.20±0.08 μg/L vs 0.25±0.07 μg/L, all P<0.05=). The lactic acid was lowered significantly in Shen-fu group (3.6±0.7mmol/L vs 4.0±0.7mmol/L, P<0.05). There were no significant differences in the number of ventilator days, ICU days, hospital days and 28-day mortality between two groups. Conclusion Shen-fu injection could strengthen systolic function ,improve MAP, decrease extravascular lung water index ,and alleviate myocardial damage in patients with septic shock and low Cardiac Output .
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