摘要
目的探讨磷酸肌酸对严重脓毒症患者心肌损伤的保护作用。方法将48例严重脓毒症并发心肌损伤患者,随机分为对照组(22例)和治疗组(26例),对照组给予脓毒症常规治疗,治疗组在对照组基础上加用磷酸肌酸1.0 g溶于生理盐水100 ml,静脉滴注,每日2次,连用5 d。治疗组和对照组分别在入ICU后和治疗后第5日抽静脉血,测CK-MB、心肌肌钙蛋白(cTnI)、B型脑利钠肽(BNP)等指标变化,记录两组患者心输出量、心脏指数、中心静脉血氧饱和度(S CV O2)的变化,多巴酚丁胺的使用时间、总剂量及治疗5 d后APACHEⅡ评分、住ICU时间、住院时间、28 d死亡率。结果治疗组治疗第5日cTnI、BNP较对照组明显下降,差异有统计学意义(P<0.05)。治疗组心输出量、心脏指数、S cv O2较对照组明显增加(P<0.05),治疗组多巴酚丁胺的使用时间及总使用量较对照组明显减少(P<0.05)。治疗组治疗5 d后的APACHEⅡ评分较对照组下降明显(P<0.05),治疗组住ICU时间较对照组明显减少(P<0.05),但两组住院时间及28 d死亡率比较差异无统计学意义(P>0.05)。结论磷酸肌酸对重度脓毒症患者受损心肌有保护作用,能改善受抑制心肌的功能,减少住ICU时间,但不能改善最终预后。
Objective To explore the protective effect of creatine phosphate on myocardial injury in severe sepsis patients. Methods 48 cases of severe sepsis patients with myocardial injury were randomly di- vided into two groups： control group （22 cases） and treatment group （26 cases）. The control group received the conventional sepsis treatment, while the treatment group received additional ereatine phosphate （ 1.0 g was dissolved in 100ml of saline, iv infusion, twice one day, dl-5） comparing with the control group. On the 1st and 5th day after treatment, the levels of MB isoenzyme of creatine kinase （CK-MB） , cardiac troponinI （cT- nI）, B-type natriuretic peptide （BNP） were determined, the cardiac output （CO）, cardiac index （CI）, cen- tral venous oxygen saturation （ SCVO2 ） were recorded, the total time and dose of dobutamine, Acute physiology and chronic health evaluation （APACHE H ） score, duration of ICU stay, total hospital stay and mortality within 28 days were recorded. Results Comparing with the control group, the cTnI and BNP of the treatment group at 5th day were significantly decreased, and the difference was statistically significant （P 〈 0. 05 ）, the CO, CI, SCVO2 of the treatment group were significantly increased （P 〈 0. 05 ）, the duration and total dose of dobutamine iv of treatment group were significantly shorter （ P 〈 0.05 ）. After the 5 days＇ treatment, the A- PACHE II score of the treatment group were significantly decreased （ P 〈 0. 05 ） and the duration of ICU stay were significantly decreased （P 〈 0. 05 ） when comparing with the control group, while the total hospital stay and mortality within 28 days of the two groups did not show significant statistical differences （ P 〉 0. 05 ）. Conclusions The creatine phosphate has protective effect for injured myocardium of severe sepsis, it can improve the function of the inhibited myocardium and reduce the duration of ICU stay, but can not improve the final prognosis.
出处
《新医学》
2013年第9期618-621,共4页
Journal of New Medicine
关键词
磷酸肌酸
脓毒症
心肌损伤
Creatine phosphate
Sepsis
Myocardial injury
