阿托伐他汀联合美托洛尔治疗脓毒症相关性心肌损伤临床疗效观察

目的：观察阿托伐他汀联合美托洛尔治疗脓毒症相关性心肌损伤的临床疗效。方法选择2014年2月至2015年12月钟祥市人民医院急诊科、呼吸科及重症医学科收治的200例严重脓毒症合并急性心肌损伤患者，按随机数字表法分为A、B、C、D四组，每组各50例。A组接受常规治疗及对症处理；B组在A组治疗基础上加用阿托伐他汀；C组在A组治疗基础上加用美托洛尔；D组在A组治疗基础上加用阿托伐他汀和美托洛尔。检测四组患者治疗前及治疗5 d后的心肌肌钙蛋白I (cTnI)、肌酸激酶同工酶(CK-MB)、钠尿肽(BNP)以及超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)浓度。结果治疗前，各组患者cTnI、CK-MB、BNP、hs-CRP、TNF-α、IL-6水平比较差异均无统计学意义(P>0.05)。治疗后，各组患者cTnI、CK-MB、BNP、hs-CRP、TNF-α、IL-6水平较治疗前均明显降低，差异均有统计学意义(P<0.05)。与A组比较，B、C、D组患者cTnI (1.60±0.42)、(1.54±0.41)、(1.04±0.42) vs (2.49±0.51)]、CK-MB (39.38±5.74)、(37.91±5.62)、(28.91±5.62) vs (62.52±5.28)]、BNP (855.58±69.13)、(804.91±69.62)、(658.26±57.62) vs (1203.26±56.92)]、hs-CRP (4.48±0.73)、(5.76±0.56)、(3.76±0.76) vs (6.65±0.71)]、TNF-α(41.28±11.27)、(49.76±11.16)、(38.76±10.16) vs (63.28±10.26)]、IL-6(31.27±4.59)、(36.76±4.16)、（21.76±5.16）vs 46.48±4.83)]水平均降低，而D组各项指标降低更为明显，差异有统计学意义(P<0.05)。治疗后，D组患者心功能改善更明显(P<0.05)。结论脓毒症早期联合使用阿托伐他汀和美托洛尔可以明显减少脓毒症患者心肌损伤程度，改善心脏功能。

Clinical effect of atorvastatin calcium combined with metoprolol in the treatment of myocardial injury in patients with severe sepsis

Objective To explore the effects of atorvastatin calcium combined with metoprolol in the treatment of myocardial injury in patients with severe sepsis. Methods A total of 200 patients with severe sepsis complicated with myocardial damage admitted in Department of Emergency, Department of Respiration and Department of Intensive Care Unit in Zhongxiang People's Hospital were selected from Feb. 2014 to Dec. 2015. All patients were divided into group A, B, C and D by random number table, with 50 patients in each group. Group A received conventional and symp-tomatic treatment, while group B, group C, group D were treated with additional atorvastatin, additional metoprolol, and additional atorvastatin and metoprolol on the basis of group A, respectively. Before treatment and after treatment for 5 d, the concentrations of cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), brain natriuretic peptide (BNP) and hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) were detect-ed in the four groups. Results Before treatment, there were no significant differences in cTnI, CK-MB, BNP, hs-CRP, TNF-αand IL-6 between the four groups (P>0.05). After treatment, the serum concentrations of cTnI, CK-MB, BNP, hs-CRP, TNF-αand IL-6 were significantly decreased than those before treatment (P<0.05). Compared with group A, the serum concentrations of cTnI, CK-MB, BNP, hs-CRP, TNF-α and IL-6 were significantly decreased in group B, group C and group D (1.60±0.42), (1.54±0.41), (1.04±0.42) vs (2.49±0.51)];(39.38±5.74), (37.91±5.62), (28.91±5.62) vs (62.52 ± 5.28)]; (855.58 ± 69.13), (804.91 ± 69.62), (658.26 ± 57.62) vs (1203.26 ± 56.92)]; (4.48 ± 0.73), (5.76 ± 0.56), (3.76 ± 0.76) vs (6.65 ± 0.71)];(41.28 ± 11.27), (49.76 ± 11.16), (38.76 ± 10.16) vs (63.28 ± 10.26)];(31.27 ± 4.59), (36.76 ± 4.16), (21.76 ± 5.16) vs (46.48 ± 4.83)]. However, the indicators of group D decreased more significantly, and the differ-ence was statistically significant (P<0.05). After treatment, the cardiac function improved significantly in group D (P<0.05). Conclusion Atorvastatin calcium combined with metoprolol can significantly reduce the severity of myocardial injury in patients with sepsis, and also improve heart function.