心脉隆注射液对脓毒症心肌抑制的临床疗效观察
发布时间：2018-10-25 12:38
【摘要】：[目的]脓毒症心肌抑制的患者,在常规抗脓毒症及针对心肌损伤治疗的基础上加用心脉隆注射液,观察相关指标的变化情况,评价临床疗效,评价心脉隆注射液用药的有效性和安全性,为临床早期应用心脉隆治疗脓毒症心肌抑制提供理论依据。[方法]从2016年3月至2017年3月,筛选就诊于昆明医科大学第一附属医院急诊ICU内的,入院后经诊断为脓毒症的患者122例,经积极液体复苏后,符合脓毒症心肌抑制标准67例,依据相关纳入、排除、脱落标准,36例患者纳入这项临床观察研究中。按照入科先后顺序及随机数字表法分为实验组(心脉隆组)(n=17)和对照组(n=19),其中女性15例,男性21例,年龄位于23-76之间。两组患者均予常规抗感染、液体复苏,改善心功能等治疗,均予深静脉穿刺置入PICCO导管连接PICCO监测仪进行监测,实验组在此基础上加用心脉隆注射液5mg/kg+0.9%氯化钠注射液200ml静脉滴注,每日2次,连续使用5天;对照组加入0.9%氯化钠注射液200ml静脉滴注,每日2次,连续使用5天。分别于治疗开始前、开始后24h、72h、120h抽取两组患者外周静脉血,检测肌钙蛋白I、B型脑利钠尿肽值,使用多普勒超声心动图监测心脏指标,记录血流动力学相关指标;于治疗前、治疗120h抽取外周静脉血检测肝肾功能,记录心率、平均动脉压情况并进行统计、分析。实验数据采用spss 19.0统计学软件包结合相关专业进行统计学分析。[结果]1、经两独立样本t检验,实验组和对照组患者年龄、身高、APECHEII评分差异均无统计学意义(P0.05)。经X2检验两组患者性别、疾病种类、血液进化差异均无统计学意义(P0.05),基线具有可比性。2、有效性指标:经重复资料方差分析,BNP、肌钙蛋白I实验组和对照组主体间、主体内效应的检验差异均有统计学意义(P0.05);左室射血分数、二尖瓣血流频谱E/A峰、E峰减速时间、三尖瓣环收缩期偏移幅度实验组和对照组主体间、主体内效应的检验差异均有统计学意义(P0.05),左室舒张末内经、左室收缩末内经实验组和对照组主体间、主体内效应的检验差异均无统计学意义(P0.05);每博量指数、外周血管阻力指数、心功能指数实验组和对照组主体间、主体内效应的检验差异均有统计学意义(P0.05),全心舒张末容积指数实验组和对照组主体间效应的检验差异无统计学意义(P0.05),主体内效应的检验差异有统计学意义(P0.05)。3、安全性指标:经两独立样本t检验,两组患者治疗前、后肝肾功能、心率、平均动脉压均无统计学意义(P0.05)。4、预后相关指标:经两独立样本t检验:两组患者机械通气时间、住ICU天数、多巴酚丁胺用量指标差异有统计学意义(P0.05),住院全因死亡率差异无统计学意义(P0.05)。5、经直接记录,实验组出1例心动过速,余无其他不良反应。[结论]1、心脉隆注射液可降低脓毒症心肌抑制患者BNP、cTnl值,提高心脏收缩、舒张功能,有一定的改善心肌损伤作用。2、心脉隆注射液对脓毒症心肌抑制患者肝肾功能、生命征无影响,无明显不良反应,可作为治疗脓毒症心肌抑制的有益补充。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7
本文编号：2293714
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7
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