【作者】 李静；

【导师】 杨志旭；

【作者基本信息】 中国中医科学院 ， 中西医结合临床， 2011， 硕士

【摘要】 目的：研究中医药干预治疗对ICU危重病非心源性心肌损伤患者急性左心衰发生率的影响。方法：采用前瞻性,完全随机对照的研究方法。严格根据诊断及纳入、排除标准将入住ICU符合非心源性心肌损伤的患者填写危重病人症候采集及辨证分型量表,其中符合中医阳气虚证的患者为研究对象,根据入院的先后顺序分发信封,患者所属组别为信封内分组。总计本次研究阶段内共有22例患者符合中医阳气虚证进入中医药干预性治疗的临床研究,其中有1例因观察周期未到转出ICU,故本研究阶段内研究对象一共21例患者,其中治疗组14例(参附注射液加常规治疗组),对照组7例(常规治疗组),检测生命体征变化,每日填写急性左心衰观察表,根据临床观察进度检测血清肌钙蛋白(cTnT)、APACHEⅡ评分、心电图、无创心功能检测相关结果(CI、CO、ACI、SVR、TRC)的变化、心脏射血分数(EF%)及中医症候量表,所得的结果进行比较分析,并比较两组患者急性左心衰的发生率的不同。结果：(1)治疗组有2例发生急性左心衰竭,占治疗组病例数14.3%；对照组有4例发生急性左心衰竭,占对照组病例数的57.1%,P<0.05差异有统计学意义。(2)治疗前治疗组与对照组辨证要素计量分别为490.57±81.345,482±93.957；治疗后治疗组与对照组辨证要素计量分别为454.071±86.578,479.286+93.136,治疗前与治疗后两组辨证要素计量比较P>0.05,无统计学差异。治疗前后治疗组的辨证要素计量比较P<0.05,提示存在统计学差异,而对照组计量比较P>0.05,提示无统计学差异。(3)治疗组在中医药干预前cTnT (0.205±0.063) ng/ml、CI(2.936±0.496) L/min/m2、CO (4.557±0.750) L/min、ACI (98.143±8.085)/100s2、SVR (1330.214±210.179) dyn×sec×cm-5、TRC (51.214±5.899)/kohm, EF% (43.286±4.304)、APACHEⅡ评分(16.786±2.045)；干预后cTnT(0.138±0.062) ng/ml、CI (3.336±0.439) L/min/m2、CO (5.278±0.545) L/min、ACI (120.429±8.045)/100s2、SVR (1205.929±90.524) dynxsecxcm-5、TRC (46.357±3.973) /kohm, EF%(45.357±4.1622)、APACHEⅡ评分(14.357±1.646)。其中心功能相关数据CI、CO、ACI、TRC、EF%、cTnT及APACHEⅡ评分的比较P<0.05存在统计学差异。结论：参附注射液可减少危重病非心源性心肌损伤中辨证属阳气虚证者急性左心衰的发生率；治疗组组内比较参附注射液能改善心肌损伤患者的心功能,表现为增强心肌收缩力,增加心输出量,提示中医药干预治疗在非心源性心肌损伤方面有重要的临床价值。更多还原

【Abstract】 Object:Research on the TCM intervention to patients in ICU medical intervention in critically ill with non-cardiac myocardial injury incidence of acute left ventricular failureMethod:using Prospective, Completely randomized Methods. Strict inclusion and exclusion criteria will be based on ICU stay consistent with non-cardiac patients with myocardial injury in critically ill patients with symptoms of complete collection and Syndromes Scale.Yang deficiency in which patients meet the Chinese as the research object,The distribution of the envelope under a hospital order,Respective groups of patients for the envelope group.The pilot phase of a total of 22 patients were found in Chinese medicine yang deficiency in early intervention into clinical trials of treatment,1 case of them not yet reached the experimental period due to transfer out of ICU, Therefore, this experimental study period a total of 21 patients, 14 patients in the experimental group(shen-fu injection and Conventional treatment group),Control group,7 cases(Conventional treatment group).Detection of changes in vital signs,complete daily observation of acute heart failure table,according to the progress of clinical trials testingThe Concentration of Troponin T(cTnT),APACHEⅡscore, ECQNon-invasive cardiac function tests relevant results(CI, CO, ACI, SVR, TRC),Ejection Fraction (EF)and The TCM symptom scale.Analysis and compare the above data,to compare the different of the two groups of patients of the incidence of acute left heart failure.Result:(1)There are 2 patients occur acute left heart failure in experimental group,the incidence of acute left heart failure is 14.3%.The control group,There are 4 patients occur acute left heart failure in the control group,the incidence of acute left heart failure is 57.1%,two groups have obvious difference (P<0.05).(2)The differentiation factor measurement of the two groups before the experimental is490.57±81.345,482±93.957.After experimental the dates change to 454.071±86. 578,479.286±93.136, there are no differences between the two groups(P>0.05),so do the patients in the control group,however,in the experimental group,the dates have obvious differences(P<0.05).(3)Before the experimental,some dates of experimental group:cTnT(0.205±0.063) ng/ml,CI(2.936±0.496)L/min/m2,CO(4.557±0.750)L/min,ACI(98.143±8.085)/100s2,S VR(1330.214±210.179)dyn×sec×cm-5, TRC(51.214±5.899)/kohm, EF%(43.286±4.304), APACHEⅡsore(16.786±2.045);After the experimental, the dates:cTnT(0.138±0.062) ng/ml, CI(3.336±0.439)L/min/m2, CO(5.278±0.545)L/min, ACI(120.429±8.045)/100s2, SVR(1205.929±90.524)dyn×sec×cm-5,TRC(46.357±3.973)/kohm, EF%(45.357±4.1622), APACHEⅡsore(14.357±1.646).Where the CI,CO, ACI, TRC, EF%, cTnT and APACHEⅡsore have differences(P<0.05).Conclusions:Shen-fu injection can reduce the incidence of acute left heart failure,which the patients in critically ill with non-cardiac myocardial and Differentiation is a yang deficiency in ICU medical intervention;Comparison of the experimental group,shen-fu injection can Improve cardiac function in patients with myocardial injury,manifast as Enhanced myocardial contractility, Increase cardiac output.Prmopt TCM intervention to non-cardiogenic myocardial injury in ICU patients has Important clinical value.更多还原