| 摘要: |
| 目的 探讨舒血宁对严重脓毒症心肌损伤患者早期心肌损伤指标和氧化应激水平的影响。方法 选择我院2013年3月至2016年6月收治的符合严重脓毒症伴心肌损伤患者102例，随机分为对照组和治疗组，各51例，对照组给予常规治疗；治疗组在常规治疗基础上加用舒血宁。记录两组患者在治疗前（入院时）及治疗后（入院后） 6 h、72 h N-末端脑钠钛前体（NT-proBNP）、心型脂肪酸结合蛋白（hFABP）、肌钙蛋白I （cTnI）、丙二醛（MDA）、超氧化物歧化酶（SOD）及谷胱甘肽过氧化物酶（GSH-Px）等各指标的变化，同时观察患者左室射血分数（LVEF）水平、急性生理学和慢性健康状况评分Ⅱ（APACHE Ⅱ）的变化，以及ICU住院时间和28 d生存情况。结果 治疗前两组患者NT-proBNP、hFABP、cTnI、MDA、SOD、GSH-Px各指标及APACHEⅡ评分、LVEF比较，差异无统计学意义（P>0.05）。治疗后6 h，治疗组患者NT-proBNP、hFABP、cTnI和MDA水平均低于对照组，SOD和GSH-Px活性均高于对照组，差异均有统计学意义（P<0.05）；两组患者NT-proBNP、hFABP、cTnI和MDA水平均较组内治疗前升高，SOD和GSH-Px活性均较组内治疗前降低（P<0.05）。治疗后72 h，两组hFABP和MDA水平均较治疗后6 h降低，NT-proBNP、cTnI水平，SOD、GSH-Px活性均较治疗后6 h升高，差异有统计学意义（P<0.05）。治疗后72 h，对照组NT-proBNP、cTnI和MDA水平均高于治疗组，SOD和GSH-Px活性均低于治疗组，差异有统计学意义（P<0.05），两组患者hFABP水平比较差异无统计学意义（P>0.05）。两组患者治疗后APACHEⅡ评分均较治疗前改善（P<0.05），而两组治疗后的LVEF和ICU住院时间差异无统计学意义（P>0.05）；治疗组患者28 d病死率低于对照组，差异有统计学意义（P<0.05）。结论 舒血宁对严重脓毒症心肌损伤患者的疗效优于常规治疗，能降低NT-proBNP、hFABP、cTnI、MDA水平和APACHEⅡ评分，提高SOD和GSH-Px活性，改善患者预后。 |
| 关键词: 脓毒症 心肌损伤 心型脂肪酸结合蛋白 N-末端脑钠肽前体 舒血宁 氧化性应激 |
| DOI：10.16781/j.0258-879x.2017.06.0804 |
| 投稿时间：2016-07-10修订日期：2017-01-20 |
| 基金项目:衡水市科学技术研究与发展计划项目（15019） |
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| Effect of Shuxuening on early myocardial injury markers and oxidative stress in severe sepsis patients with myocardial injury |
| CHU Yong-guo1,QI Hong-na1*,ZHANG Jian-jun2,HE Jia-qi1,WANG Wei-zhan1,LI Ya-qin1 |
(1. Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Hebei, China;
2. Department of Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Hebei, China
*Corresponding author) |
| Abstract: |
| Objective To explore the effect of Shuxuening on early myocardial injury markers and oxidative stress in severe sepsis patients with myocardial injury. Methods A total of 102 severe sepsis patients with myocardial injury, who received therapy in our hospital from Mar. 2013 to Jun. 2016, were randomly divided into two groups: control group (51 cases) and therapy group (51 cases). The patients in the control group received routine treatments and the therapy group were given Shuxuening based on routine treatment. We detected the levels of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid binding protein (hFABP), cardiac troponin I (cTnI), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) of patients before treatment (at admission), after treatment for 6 h and 72 h (after admission), and analyzed the change of left ventricular ejection fraction (LVEF), acute physiology, chronic health evaluation (APACHE) Ⅱ score, length of ICU stay and 28-day mortality of the patients. Results At admission, there was no difference in the levels of plasma NT-proBNP, hFABP, cTnI, MDA, SOD, GSH-Px, APACHE Ⅱ score or LVEF between the two groups (P>0.05). After treatment for 6 h, the levels of plasma NT-proBNP, hFABP, cTnI and MDA in the therapy group were significantly lower and the activities of plasma SOD and GSH-Px were significantly higher than those in the control group (P<0.05); the two groups both had significant increases in the levels of NT-proBNP, hFABP, cTnI and MDA and significant decreases in the activities of SOD and GSH-Px compared with those before treatment (P<0.05). After treatment for 72 h in the two groups, the levels of plasma hFABP and MDA were significantly lower and the levels of plasma NT-proBNP and cTnI, the activities of SOD and GSH-Px were significantly higher than those after treatment for 6 h (P<0.05). After treatment for 72 h, the levels of plasma NT-proBNP, cTnI and MDA in control group were significantly higher and the activities of plasma SOD and GSH-Px were significantly lower than those in the therapy group (P<0.05), with the difference in the hFABP levels being similar in the two groups (P>0.05). APACHE Ⅱ scores after treatment were significantly lower than that before treatment in the two groups (P<0.05), and no significant difference was found in the LVEF or the length of ICU stay after treatment between the two groups (P>0.05). The therapy group had a significantly lower 28-day mortality than the control group (P<0.05).The therapy group had a significantly lower mortality than the control group (P<0.05). Conclusion Therapeutic effect of Shuxuening on the severe sepsis patients with myocardial injury is superior to the routine treatment. Shuxuening can decrease the levels of NT-proBNP, hFABP, cTnI, and MDA and APACHE Ⅱscore, and can increase the activities of SOD and GSH-Px. |
| Key words: sepsis myocardium injury heart fatty acid binding protein N-terminal pro-brain natriuretic peptide Shuxuening oxidative stress |
