目的 探討血必凈注射液與重組人腦利鈉肽聯(lián)合使用在治療膿毒癥心肌病方面的臨床效果。方法 納入2022年8月—2023年8月在河北省中醫(yī)院診治的膿毒癥心肌病患者60例，隨機(jī)分為對(duì)照組和治療組，每組各30例。對(duì)照組靜脈泵入注射用重組人腦利鈉肽，初始靜脈推注1.5 μg/kg負(fù)荷劑量，隨后按照0.007 5 μg/(kg∙min)靜脈連續(xù)泵入治療。治療組患者在對(duì)照組基礎(chǔ)上靜脈滴注血必凈注射液，50 mL加入100 mL生理鹽水，2次/d。兩組患者均接受為期7 d的治療。觀察兩組患者臨床療效，比較治療前后兩組患者格拉斯哥昏迷評(píng)分（GCS）、器官功能衰竭（SOFA）評(píng)分、呼吸機(jī)輔助時(shí)間、ICU住院時(shí)間、28 d病死率，及高敏心肌肌鈣蛋白T（hs-cTnT）、N末端腦鈉肽前體（NT-proBNP）、肌酸激酶同工酶（CK-MB）、C反應(yīng)蛋白（CRP）、白細(xì)胞介素-6（IL-6）和白細(xì)胞介素-8（IL-8）水平。結(jié)果 治療后，對(duì)照組與治療組的臨床總有效率分別為63.33%、86.67%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療后，兩組GCS評(píng)分比治療前明顯升高，而SOFA評(píng)分明顯降低（P＜0.05），且治療組GCS評(píng)分和SOFA評(píng)分均顯著優(yōu)于對(duì)照組（P＜0.05）。治療后，治療組膿毒癥心肌病患者呼吸機(jī)輔助時(shí)間、ICU住院時(shí)間和28 d病死率均明顯低于對(duì)照組（P＜0.05）。治療后，兩組hs-cTnT、NT-proBNP、CK-MB、CRP、IL-6和IL-8水平比同組治療前明顯降低（P＜0.05），且治療組這些血清因子水平顯著低于對(duì)照組（P＜0.05）。結(jié)論 血必凈注射液聯(lián)合重組人腦利鈉肽治療膿毒癥心肌病療效顯著，不僅能夠顯著改善患者的病情嚴(yán)重程度并縮短呼吸機(jī)輔助和ICU住院時(shí)間，而且減輕了患者的心肌損傷和體內(nèi)炎癥反應(yīng)水平，從而降低了28 d病死率。

Objective To explore the clinical efficacy of Xuebijing Injection combined with recombinant human brain natriuretic peptide in treatment of septic cardiomyopathy.Methods Patients (60 cases) with septic cardiomyopathy in Hebei Provincial Traditional Chinese Medicine Hospital from August 2022 to August 2023 were randomly divided into control and treatment group, and each group had 30 cases. Patients in the control group were iv administered with Recombinant Human Brain Natriuretic Peptide for injection, the initial intravenous bolus loading dose of 1.5 μg/kg was injected, followed by continuous intravenous pumping at 0.007 5 μg/kg/min. Patients in the treatment group were iv administered with Xuebijing Injection on the basis of the control group, 50 mL added into normal saline 100 mL, twice daily. Patients in two groups were treated for 7 d. After treatment, the clinical evaluations were evaluated, and the GCS scores, SOFA scores, ventilator-associated time, ICU stay time, 28 d mortality rate, and the levels of hs-cTnT, NT-proBNP, CK-MB, CRP, IL-6 and IL-8 in two groups before and after treatment were compared.Results After treatment, the total clinical effective rates in the control group and the treatment group were 63.33% and 86.67%, respectively, and the difference between the two groups was statistically significant (P < 0.05). After treatment, the GCS score in two groups was significantly higher than before treatment, while the SOFA score was significantly lower (P < 0.05), and the scores in the treatment group were significantly better than that in the control group (P < 0.05). After treatment, the ventilator assistance time, ICU stay time and 28-d mortality rate in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of hs-cTnT, NT-proBNP, CK-MB, CRP, IL-6, and IL-8 in two groups were significantly lower than those in the same group before treatment (P < 0.05), and the levels of these serum factors in the treatment group was significantly lower than those in the control group (P < 0.05).Conclusion The combination therapy of Xuebijing Injection and recombinant human brain natriuretic peptide for sepsis-induced cardiomyopathy is significantly effective, not only improving the severity of the disease, reducing the duration of ventilator assistance and ICU stay, but also alleviating myocardial damage and systemic inflammatory response levels, thereby reducing the 28 d mortality rate.

R972

河北省中醫(yī)藥管理局科研計(jì)劃項(xiàng)目（2022062）；政府資助臨床醫(yī)學(xué)優(yōu)秀人才培養(yǎng)項(xiàng)目（ZF2024158）