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目的:观察清源生化汤对严重骨创伤后脓毒症患者心肌损伤及心脏功能的影响。方法:将2013年3月-2014年12月河南省洛阳正骨医院重症医学科收治的60例严重骨创伤后脓毒症患者按随机数字表法分为中西医结合治疗组(32例)和西医对照组(28例)。两组均参照2012年严重脓毒症及脓毒性休克治疗国际指南进行西医常规治疗;中西医结合治疗组在常规西医治疗基础上,采用自制中药清源生化汤300m L,每日1剂,分2次服。两组疗程均为7d。分别于治疗前及治疗后1、3、7d采血,检测血浆肌酸激酶同工酶(CK-MB)、超敏心肌肌钙蛋白T(hs-c Tn T)及N末端脑利钠肽前体(NT-pro BNP)含量;治疗前及治疗后7d行彩色多普勒超声检查,测量左心室射血分数(LVEF)、舒张早期/晚期心室充盈速度最大值比值(E/A比值)、左室舒张期末容积指数(LVEDVI)及左室收缩期末容积指数(LVESVI)。结果:随治疗时间延长,两组CK-MB、hs-c Tn T和NT-pro BNP均明显改善,以中西医结合治疗组7d时hs-c Tn T、NT-Pro BNP改善更为明显(P<0.05);而两组各时间点CK-MB均无明显差异。治疗后7d,西医对照组仅E/A比值和LVEDI明显改善,而中西医结合治疗组各心功能指标均较治疗前明显改善,且明显优于西医对照组(P<0.05)。结论:清源生化汤联合西医常规疗法治疗严重骨创伤后脓毒症,可降低患者心肌受损程度、改善心功能,对心脏具有很好的保护作用。
Objective: To observe the effect of Qingyuan Shenghua Decoction on myocardial injury and cardiac function in septic patients with severe bone trauma. Methods: From March 2013 to December 2014, 60 cases of severe post-traumatic septic sepsis admitted to Department of Critical Care Medicine, Luoyang Orthopedics Hospital of Henan Province were divided into three groups according to random number table: Control group (28 cases). Both groups were treated with Western medicine in accordance with the international guidelines for the treatment of severe sepsis and septic shock in 2012. Traditional Chinese and western medicine combined with traditional Chinese medicine treatment based on the traditional Chinese medicine Qingyuan Biochemical Decoction 300m L a day, 2 times service. Two courses of treatment are 7d. Blood samples were collected before treatment and at 1, 3 and 7 days after treatment. Plasma concentrations of CK-MB, hs-c Tn T, and N-terminal pro-brain natriuretic peptide (NT-pro BNP) were measured before and after 7 days of treatment. Color Doppler echocardiography was performed before and after treatment to measure left ventricular ejection fraction (LVEF) and early / late diastolic ventricular filling velocity (E / A ratio) Left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI). Results: The CK-MB, hs-c Tn T and NT-pro BNP in both groups were significantly improved with the prolongation of treatment time. The improvement of hs-c Tn T and NT-Pro BNP was more obvious P <0.05). There was no significant difference in CK-MB between the two groups at each time point. At 7 days after treatment, only the E / A ratio and LVEDI in the western medicine group were significantly improved. However, the indexes of cardiac function in the Western medicine group were significantly improved compared with those before treatment, and were significantly better than those in the western medicine group (P <0.05). Conclusion: Qingyuan Shenghua Decoction combined with Western conventional therapy in the treatment of severe post-traumatic sepsis can reduce the degree of myocardial damage and improve cardiac function, which has a good protective effect on the heart.