丹红联合持续性肾脏替代治疗对严重脓毒症患者心肌损伤的保护疗效观察

摘要

目的 探讨丹红注射液和持续性肾脏替代治疗(CRRT)联合应用对严重脓毒症患者心肌损伤是否具有保护作用.方法 将160例严重脓毒症合并心肌损伤的患者随机分为对照组(A组)、丹红组(B组)、CRRT组(C组)和丹红联合CRRT组(D组).在治疗前及治疗后第7天这二个时间节点,分别检测肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、动脉血乳酸(LAC)、肌酸激酶同工酶MB(CK-MB)、肌钙蛋白I(cTnI)和脑利钠肽(BNP);记录患者APACHEⅡ评分和治疗后7~30d发生的心脏事件(急性心力衰竭、急性心肌梗死、恶性心律失常)及转归情况.结果 治疗前四组各项指标差异无统计学意义(P>0.05);与A组比较,治疗后B组LAC变化不明显(P>O.05),D组TNF-α、IL-6、LAC、cTnI、CK-MB、BNP和APACHEⅡ评分明显降低(P<0.05);与A组比较,B组心力衰竭和C组急性心肌梗死发病率变化不明显(P>0.05),D组心衰、心梗的发病率和30d病死率均显著降低(P<0.05).结论 丹红注射液联合CRRT治疗对严重脓毒症患者心肌损伤具有保护作用,能够改善患者预后及降低病死率.%Objective To investigate the protective effect of Danhong injection combined with continuous renal replacement therapy(CRRT) on myocardial injury in patients with severe sepsis. Methods 160 patients with severe sepsis complicated with myocardial injury were randomly divided into control group(group A),Danhong group(group B),group CRRT(group C)and Danhong combined with CRRT group(group D). On seventh day before and after treatment,tumor necrosis factor alpha(TNF- alpha),interleukin -6(IL-6),arterial blood lactic acid(LAC), creatine kinase isoenzyme MB(CK-MB),troponin I(cTnI)and brain natriuretic peptide(BNP) were detected;the cardiac events(acute heart failure,acute myocardial infarction,malignant arrhythmia) and outcomes after 7~30d treatment and the APACHE scores were recorded.. Results No statistically significant difference between treatment group in the four indexes(P>0.05);compared with A group and B group, LAC did not significantly change after treatment(P>0.05),D group,IL-6 LAC,TNF- a,cTnI,CK-MB,BNP and APACHE score decreased significantly(P<0.05);compared with A group,B group and C heart failure group the incidence of acute myocardial infarction did not change significantly(P>0.05),D group's heart failure,myocardial infarction morbidity and mortality of 30d were significantly lower(P<0.05). Conclusion Danhong injection combined with CRRT has a protective effect on myocardial injury in patients with severe sepsis,which can improve the prognosis and reduce mortality.