Objective To investigate the effects of Shuxuening on heart-type fatty acid binding protein (H-FABP),tumor necrosis factor-a(TNF-a) and interleukin-6 (IL-6) in severe sepsis patients with myocardial depression.Methods Totally 86 severe sepsis patients with myocardial depression from January 2013 to April 2016 in Harrison International Peace Hospital were randomly divided into control group and observation group,with 43 cases in each group.The control group was treated with routine treatment;the observation group was treated with Shuxuening injection 20 ml added into 0.9％ sodium chloride injection 250 ml,1 time/d intravenous injection for 14 d.Serum levels of H-FABP,cardiac troponin I (cTnI),TNF-α and IL-6 were detected before and 6 h,3 d after treatment.Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and cumulative incidence of major adverse cardiac events (MACE) were analyzed.Results Before treatment,there were no significant differences of H-FABP,cTnI,TNF-α,IL-6 and APACHE Ⅱ score between groups [(24.5 ± 7.0)μg/L vs (25.1 ±6.6)μg/L,(0.004 1 ±0.003 2) μg/L vs (0.003 2 ±0.002 3) μg/L,(26 ±7)ng/L vs (26 ± 6) ng/L,(40 ± 8) ng/L vs (40 ± 9) ng/L,(24 ± 7) scores vs (24 ± 6) scores] (P ＞ 0.05).After 6 h of treatment,H-FABP,cTnI,TNF-α,IL-6 and APACHE Ⅱ scores were significantly higher than those before treatment in both groups;these indexes in observation group were significantly lower than those in control group [(35.4 ±8.1) μg/L vs (40.6 ± 10.2) μg/L,(0.982 3 ±0.143 5) μg/L vs (1.594 6 ±0.261 7) μg/L,(34 ± 9) ng/L vs (39 ± 9) ng/L,(42 ± 7) ng/L vs (46 ± 8) ng/L,(17 ± 5) scores vs (20 ± 6) scores] (all P ＜ 0.05).After 3 d of treatment,H-FABP,TNF-α,IL-6 and APACHE Ⅱ scores were significantly lower those after 6 h of treatment;cTnI was significantly higher than that after 6 h of treatment;levels of TNF-α,IL-6,APACHE Ⅱ score and cTnI in observation group were significantly lower than those in control group [(2.057 6 ± 0.326 2) μg/L vs (2.682 9 ±0.543 4) μg/L,(21 ±6)ng/L vs (25 ±5)ng/L,(30 ± 6) ng/L vs (35 ±7) ng/L,(11 ±4) scores vs (15 ± 4) scores] (all P ＜ 0.05);H-FABP had no significant difference between groups (P ＞ 0.05).The observation group had a lower cumulative incidence of MACE compared to control group and the difference was significant [7.0％ (3/43) vs 23.3％ (10/43)] (x2 =4.440,P =0.035).Conclusion Shuxuening can reduce tissue hypoxia,decrease TNF-α,IL-6 levels and lessen inflammatory reaction;it is effective in the treatment of patients with severe sepsis and myocardial depression.%目的 探讨舒血宁治疗严重脓毒症心肌抑制患者的效果及对心脏型脂肪酸结合蛋白(H-FABP)和肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)的影响.方法 选择哈励逊国际和平医院2013年1月至2016年4月收治的严重脓毒症伴心肌抑制患者86例,按照随机数字表法分为对照组和观察组,各43例.对照组给予常规治疗,观察组在对照组基础上加用舒血宁注射液20 ml加入0.9％氯化钠注射液250ml,1次/d静脉滴注,连用14 d.2组患者均在治疗前及治疗后6h、3d检测H-FABP、心肌肌钙蛋白I(cTnI)、TNF-α、IL-6水平,同时观察患者急性生理和慢性健康状况(APACHE)Ⅱ评分及主要心脏不良事件(MACE)发生率.结果 治疗前观察组与对照组患者H-FABP、cTnI、TNF-α、IL-6水平和APACHEⅡ评分差异无统计学意义[(24.5±7.0)μg/L比(25.1±6.6)μg/L、(0.004 1 ±0.003 2)μg/L比(0.003 2±0.002 3)μg/L、(26 ±7) ng/L比(26±6)ng/L、(40±8)ng/L比(40±9)ng/L、(24 ±7)分比(24±6)分](P＞0.05).治疗后6h,2组患者以上指标均较本组治疗前升高,且观察组低于对照组[(35.4±8.1)μg/L比(40.6±10.2) μg/L、(0.982 3±0.143 5)μg/L比(1.594 6±0.261 7) μg/L、(34±9) ng/L比(39±9) ng/L、(42±7)ng/L比(46±8)ng/L、(17±5)分比(20±6)分],差异均有统计学意义(均P＜0.05).治疗后3d,2组H-FABP、TNF-α、IL-6水平和APACHEⅡ评分均较治疗后6h降低,cTnI较治疗后6h升高,差异有统计学意义(P＜0.05);观察组cTnI、TNF-α、IL-6水平和APACHEⅡ评分均低于对照组[(2.057 6±0.326 2)μg/L比(2.682 9±0.543 4)μg/L、(21±6) ng/L比(25±5)ng/L、(30±6) ng/L比(35±7) ng/L、(11±4)分比(15±4)分],差异均有统计学意义(均P＜ 0.05),2组患者H-FABP比较差异无统计学意义(P＞0.05).观察组累计MACE发生率明显低于对照组,差异有统计学意义[7.0％ (3/43)比23.3％(10/43),x2 =4.440,P=0.035].结论 脓毒症心肌抑制患者早期给予舒血宁治疗,可改善组织缺氧,降低血清炎性因子TNF-α、IL-6水平,减轻机体炎性反应,改善患者预后,临床疗效明显.
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