摘要
目的探讨左西孟旦对脓毒症心肌抑制患者左心室收缩功能、血流动力学及心肌损伤标志物水平的影响。方法选取2017年1月—2019年10月石家庄市第一医院重症医学科一病区收治的脓毒症心肌抑制患者60例作为研究对象,随机数字表法将其分为对照组和研究组,每组30例,2组患者均接受常规基础治疗,对照组在常规基础治疗上加用多巴酚丁胺治疗,研究组加用左西孟旦治疗,均连续治疗7 d。治疗前后比较2组患者左心室收缩末期容积指数(LVESI)、左心室舒张末期容积指数(LVEDI)、左心室射血分数(LVEF)、平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、血清乳酸浓度(LAC)、心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)水平及机械通气时间、ICU住院时间、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官功能衰竭评分(SOFA)、28 d病死率。结果与治疗前比较,2组患者治疗7 d时LVESI、LVEDI、APACHEⅡ评分、SOFA评分均显著降低,LVEF显著升高,差异具有统计学意义(P<0.05);治疗7 d时,与对照组比较,研究组LVESI、LVEDI、LVEF、APACHEⅡ、SOFA评分改善更显著(t/P=6.218/0.001,7.362/0.001,5.216/0.007,6.923/0.001,5.173/0.021)。与治疗前比较,2组患者治疗7 d时MAP、CVP显著升高,HR、LAC显著降低(P<0.05);治疗7 d时,与对照组比较,研究组MAP、CVP升高更明显,HR、LAC降低更显著(t/P=4.126/0.029,3.967/0.031,5.243/0.021,5.614/0.011)。与治疗前比较,2组患者治疗7 d时cTnI、BNP均显著降低(P<0.05),治疗7 d时,与对照组比较,研究组cTnI、BNP降低更显著(t/P=3.614/0.033,3.862/0.027)。与对照组比较,研究组机械通气时间、ICU住院时间均明显缩短(t/P=6.182/0.009、6.724/0.001);随访28 d期间研究组病死率明显低于对照组(16.68%vs.33.33%,χ~2=21.561,P=0.001);2组患者治疗期间均未出现严重不良反应。结论脓毒症心肌抑制患者在常规治疗基础上结合左西孟旦疗效确切,能有效增强患
Objective To explore the effect of levosimendan on left ventricular systolic function,hemodynamics and the levels of myocardial injury markers in patients with septic myocardial depression.Methods From January 2017 to October 2019,60 patients with septic myocardial suppression admitted to the First Ward of the Department of Intensive Care Medicine of Shijiazhuang First Hospital were selected as the research objects.Random number table method was used to divide them into a control group and a study group,30 patients in each group.Both groups received conventional basic treatment.The control group was treated with dobutamine in addition to the conventional basic treatment.The study group was treated with levosimendan for 7 consecutive days.Before and after treatment,the left ventricular end systolic volume index(LVESI),left ventricular end diastolic volume index(LVEDI),left ventricular ejection fraction(LVEF),mean arterial pressure(MAP),heart rate(HR),and central venous pressure(CVP)were compared between the two groups before and after treatment.Serum lactic acid concentration(LAC),cardiac troponin I(cTnI),brain natriuretic peptide(BNP),level and duration of mechanical ventilation,ICU length of stay,acute physiology and chronic health status score systemⅡ(APACHEⅡ)Score,Sequential organ failure score(SOFA),28-day case fatality rate.Results Compared with before treatment,the LVESI,LVEDI,APACHEⅡscores,and SOFA scores of the two groups were significantly reduced after 7 days of treatment,and the LVEF was significantly increased,the difference was statistically significant(P<0.05).At 7 days of treatment,compared with the control group The scores of LVESI,LVEDI,LVEF,APACHEⅡ,and SOFA in the study group improved significantly(t/P=6.218/0.001,7.362/0.001,5.216/0.007,6.923/0.001,5.173/0.021).Compared with before treatment,MAP and CVP of the two groups were significantly increased at 7 days of treatment,while HR and LAC were significantly decreased(P<0.05).At 7 days of treatment,compared with the control group,the MAP
作者
刘红娟
耿静
何志红
郎哲
孟文格
胡晓宁
Liu Hongjuan;Geng Jing;He Zhihong;Lang Zhe;Meng Wenge;Hu Xiao ning(Department of Critical Care,The First Hospital of Shijiazhuang City,Hebei Province,Shijiazhuang 050000,China)
出处
《疑难病杂志》
CAS
2021年第4期348-352,共5页
Chinese Journal of Difficult and Complicated Cases
基金
石家庄市科学技术研究与发展计划项目(171461383)。
关键词
脓毒症
心肌抑制
左西孟旦
左心室收缩功能
血流动力学
心肌损伤标志物
Sepsis
Myocardial inhibition
Levosimendan
Left ventricular systolic function
Hemodynamics
Markers of myocardial injury
