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目的:探讨脓毒症休克患者分别应用左西孟旦(LEV)与多巴酚丁胺(Dob)对心肌抑制的改善效果。方法:选取我院2014年7月~2016年6月收治的63例脓毒症休克患者,依照随机数字表法分为观察组(31例)和对照组(32例)。两组均给予常规基础治疗,在其基础上,对照组予以Dob治疗,观察组给予LEV治疗。记录比较两组治疗前后左室收缩期末容积指数(LVESI)、左室舒张期末容积指数(LVEDI)及左心射血分数(LVEF)、心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,预后情况。结果:与治疗前比较,两组治疗7 d时LVESI、LVEDI、LVEF,均显著改善(P<0.01);且观察组改善程度较对照组相比,更为显著(P<0.01);两组治疗7d时血清cTnI、BNP水平和APACHEⅡ评分,均显著低于治疗前(P<0.01);与对照组治疗7d时相比,观察组心肌损伤指标及APACHEⅡ评分改善程度均更为显著(P<0.01);观察组28d生存率为54.8%略高于对照组的50.0%,但组间差异无统计学意义(P>0.05)。结论:脓毒症休克患者应用LEV更有利于提高心脏功能,稳定病情,改善心肌抑制,具有较高临床推广价值。
Objective: To investigate the effect of levosimendan (LEV) and dobutamine (Dob) on myocardial infarction in septic shock patients. Methods: Seventy-three septic shock patients admitted to our hospital from July 2014 to June 2016 were randomly divided into observation group (31 cases) and control group (32 cases). Both groups were given routine basic treatment, on the basis of which, the control group was treated with Dob and the observation group with LEV treatment. The left ventricular end-systolic volume index (LVESI), left ventricular end-diastolic volume index (LVEDI), left ventricular ejection fraction (LVEF), cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) And acute physiology and chronic health status score system Ⅱ (APACHE Ⅱ) score and prognosis. Results: LVESI, LVEDI and LVEF were significantly improved in both groups at 7 d after treatment (P <0.01), and the improvement in the observation group was more significant than that in the control group (P <0.01) Serum cTnI, BNP level and APACHEⅡscore at 7d after treatment were significantly lower than those before treatment (P <0.01). Compared with the control group at 7d, the indexes of myocardial injury and APACHEⅡscore in the observation group were more significant (P < 0.01). The 28-day survival rate in the observation group was 54.8% slightly higher than that in the control group (50.0%), but there was no significant difference between the two groups (P> 0.05). Conclusion: The application of LEV in patients with septic shock is more conducive to improve cardiac function, stable disease, improve myocardial suppression, with high clinical value.