摘要
目的探讨益气活血中药对脓毒症心肌抑制的保护作用及其可能机制。方法采用前瞻性、单盲、随机对照试验，选择2007年7月至2010年1月广东省中医院重症监护病房（ICU）脓毒症患者57例，按完全随机原则1：1分为治疗组（29例）和对照组（28例）。对照组按“拯救脓毒症战役”（SSC）指南推荐的方案给予常规治疗；治疗组在对照组基础上给予中药通冠胶囊3粒，每日3次；两组均治疗7d。于治疗1d、7d进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，并检测肌钙蛋白I（cTnI）、B型利钠肽（BNP）、肌酸激酶同工酶（CK—MB）、肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）水平，用超声心动图评价心脏功能；记录7、28、90d生存率。结果两组治疗7dAPACHEII评分、cTnI、BNP、炎症因子及超声心动图等指标均较1d有不同程度的改善（均P〈0．01）；以治疗组治疗7dAPACHEⅡ评分、cTnI、BNP、IL-6、左室射血分数（LVEF）、舒张早期／晚期心室充盈速度最大值比值（E／A比值）、左室舒张期末容积指数（LVEDVI）较对照组改善更明显（APACHEⅡ评分（分）：23．15±3．63比25．42±4．37，cTnI（ng／L）：0．530±0．316比0．781±0．426，BNP（ng／L）：148．15±37．65比245．59±65．92，IL-6（ng／L）：712．29±50．95比646．75±50．57，LVEF：0．54±0．08比0．50±0．08，E／A比值：1．25±0．10比1．18±0．10，LVEDVI：41．40±6．99比46．94±4．85，P〈0．05或P〈0.01]，CK—MB、左室收缩期末容积指数（LVESVI）差异均无统计学意义（均P〉0．05）。两组患者治疗7、28、90d生存率比较差异均无统计学意义。结论脓毒症心肌抑制是以舒张功能损害为主，益气活血中药能保护脓毒症心肌抑制，可能与其降低血清IL-6等炎症因子水平有关。
Objective To evaluate the protective effect of benefiting Qi and promoting blood circulation （益气活血）, a traditional Chinese medicine （TCM）, for treatment of patients with myocardial depression induced by sepsis and to investigate its possible mechanism. Methods A prospective, single blind, random control trial was carried out, and 57 patients with sepsis admitted in intensive care unit （ICU） of Guangdong Provincial Hospital of TCM from July 2007 to January 2010 were enrolled. Patients were divided into treatment group （29 patients） and control group （28 patients）. The patients in control group accepted classical surviving sepsis campaign （SSC） therapy, and the patients in treatment group, besides the conventional therapy, received 3 grains of TCM Tongguan capsule （通冠胶囊）, 3 times a day. The treatment course was 7 days in both groups. Acute physiology and chronic health evaluation II （APACHE II ） scores were performed, the levels of troponin I （cTnI）, B-type natriuretic peptide （BNP）, MB isoenzyme of creatine phosphokinase （CK-MB）, tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6） were determined, and the cardiac function was detected by echocardiography technique on the 1st and 7th day after treatment. Survival rates on 7, 28 and 90 days were recorded. Results Compared to the data on the 1st day after treatment, on the 7th day, the APACHE I score, cTnI, BNP, inflammatory factors and cardiac function were all improved in various degrees in both groups （all P〈0.01）. The APACHE II score, cTnI, BNP, IL-6, left ventricular ejection fraction （LVEF）, mitral early diastolic filling velocity/late diastolic filling velocity （E/A）, left ventricular end-diastolic volume index （LVEDVI） on the 7th day in treatment group were improved more significantly compared with those in control group [APACHE 11 score： 23.15±3.63 vs. 25.42±4.37, cTnI （ng/L）：0. 530±0. 316 vs. 0. 781±0. 426, BNP （ng/L） ： 148.15±37.65 vs. 245.59±65.92, IL-6 （ng/L）： 712.29±50.95 vs. 646.75±50.57, LVEF： 0.54±0.08vs. 0.50±0.08, E/A： 1.25±0.10vs. 1.18d：0.10, LVEDVI： 41.40±6.99 vs. 46.94±4.85, P〈0. 05 or P〈0. 01]. There was no statistical significant difference in CK-MB and left ventricular end-systolic volume index （LVESVI） between two groups （both P〉 0. 05）. There were no statistical significant differences in survival rates on the 7th, 28th and 90th day between the two groups. Conclusion The cardiac diastolic function is primarily impaired in patients with myocardial depression induced by sepsis. The TCM method of benefiting Qi and promoting blood circulation can improve the situation of myocardial depression, and the mechanism is possibly related to the lowering of the levels of inflammatory factors including IL-6.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2011年第3期163-166,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
脓毒症
心肌抑制
益气活血法
中医药
Sepsis
Myocardial depression
Method of benefiting Qi and promoting blood circulation
Traditional Chinese medicine
