早期目标指导治疗对严重脓毒症/脓毒性休克患者心肌的保护作用机制

目的研究早期目标指导治疗(EGDT)对严重脓毒症/脓毒性休克患者心肌的保护作用机制。方法采用前瞻性对照研究,将100例严重脓毒症/脓毒性休克患者随机分为EGDT治疗组和对照组,每组50例。EGDT治疗组予以早期目标指导治疗,对照组予以常规液体复苏治疗,分别测定液体复苏前及复苏后第3、7、14天血清肌钙蛋白I(cTnI)、高敏C-反应蛋白(hs-CRP)、A-PACHEⅡ评分等。分析cTnI与hs-CRP的相关性。结果液体复苏前,EGDT治疗组与对照组cTnI水平分别为0.59±0.66和0.54±0.48μg/L,两组间无明显差异且均高于正常值(P>0.05)。经EGDT治疗后,EGDT治疗组7、14d时的cTnI水平分别为0.16±0.22和0.09±0.13μg/L,明显低于对照组(分别为0.39±0.43和0.29±0.29μg/L)且恢复正常(P<0.05),hs-CRP有相同变化趋势(P<0.05)。相关性分析显示hs-CRP与cTnI呈正相关(复苏前及复苏后3、7、14d分别为r0=0.818,r3=0.858,r7=0.795,r14=0.739,P<0.05);与复苏前比较,复苏后EGDT治疗...

Effect of early goal-directed therapy on myocardial protection in severe sepsis/septic shock patients

Objective To investigate the mechanism of early goal-directed therapy (EGDT) on myocardium protection in severe each).Patients in EGDT group were given with EGDT, and in control group with standard fluid resuscitation therapy.The concentration of cardiac troponin Ⅰ (cTnI) and high sensitivity C-reactive protein (hs-CRP) in serum, and APACHEⅡ score of all the patients were determined and recorded on the 0 day (the day before initiation of treatment) and the 3rd, 7th and 14th days after the resuscitation.The corrdation between cTnI and hs-CRP was then analysed.Rasults The level of cTnI was 0.59±0.56 and 0.54±0.48μg/L, respectively, in EGDT group and control group.The cTnI levels were higher than the normal in both groups, and no difference existed (P>0.05) between two groups.After EGDT, the level of eTnI in EGDT group was obviously dowered on the 7th day (0.16±0.22μg/L) and 14th day (0.09±0.13μg/L) compared with those in control group (0.39±0.43, 0.29±0.29μg/L, P<0.05).The level of cTnI in EGDT group returned to normal at the end of present study.The level of hs-CRP showed the similar trend as that of cTnI (P<0.05).A positive correlation existed between cTnI and hs-CRP at each time point (r_0=0.818, r_3=0.858, r_7 =0.795 and r_(14)=0.739, P<0.05).APACHE Ⅱscore significantly declined in EGDT group compared with that in control group after the resuscitation (P<0.05).Obviously higher 28-day survival rate and longer survival time were found in patients of EGDT group than those in control group 76% vs 52%, (24.1±1.1)d vs (9.6±1.4)d, P<0.05].Conclusion EGDT could protect myocardiac muscle of severe sepsis/septic shock patients by suppressing inflammation.