乌司他丁联合大黄对脓毒症心肌损伤的保护作用

摘要

目的：探讨乌司他丁联合大黄对脓毒症患者心肌损伤的保护作用。方法选取2014年10月至2015年10月期间，急诊科和 ICU 病房收治的脓毒症患者90例，随机分为对照组、乌司他丁组（治疗组）与乌司他丁联合大黄组（联合组）三组，各30例。对照组患者给予抗脓毒症集束化治疗，治疗组在对照组基础上加用乌司他丁治疗，联合组在治疗组基础上加用大黄治疗，连续治疗1周，抽取三组患者的静脉血检测心肌肌酸激酶同工酶（CK - MB）、心肌肌钙蛋白（c - TNI）、N 端前脑钠肽（NT - proBNP）及肿瘤坏死因子α（TNF -α），监测急性生理和慢性健康状况评分（APACHEⅡ评分）、超声心动图心功能及多脏器功能衰竭（MODS）发生率的变化。结果①治疗1周后，治疗组、联合组的 CK -MB、c - TNI、NT - proBNP 和 TNF -α 值比对照组均有下降，比较差异有统计学意义（ P <0.05），且联合组优于治疗组。②三组 APACHEⅡ评分及 MODS 发生率均低于治疗前，超声心动图示心功能有所改善，且联合组比对照组及治疗组下降的更为明显（ P <0.05）。结论乌司他丁对脓毒症患者的心肌损伤具有保护作用，且联合应用大黄对脓毒症患者的心肌损伤疗效更显著，值得在临床中推广应用。%Objectiye To investigate the protective effect of ulinastatin combined with rhubarb on myocardial injury patients with severe sepsis. Methods From October 2014 to October 2015,90 patients with severe sepsis myocardial injury treated in our hospital Emergency Depart-ment and ICU were randomly divided into control group ,treated group and combined group. Each group included 30 cases. The control group was given conventional anti - sepsis cluster. The treated group was combined plus ulinastatin,and combined group was given rhubarb in treated group basisy. After one week,the blood was collected to determine CK - MB,c - TNI,NT - proBNP ,TNF - α. The APACHEⅡscore,heart function and the MODS incidence rate were observed. Results ①After treatment,CK - MB,c - TNI,NT - proBNP and TNF - αwere significantly differ-ent in the treated group and the combined group( P < 0. 05),and the combined group was better than that of the treated group. ②APACHEⅡscore and the MODS incidence rate were lower than those in the three groups before treatment. And the combined group was decreased more signifi-cantly than the control group and treated group( P < 0. 05). Conclusion Ulinastatin can effectively protect myocardial sepsis patients,com-bined application of ulinastatin and rhubarb was more significant. It is worth popularizing in clinical widely.