摘要
目的探讨尼莫地平在危重烧伤脓毒症防治中的作用。方法将28例危重烧伤脓毒症病例随机分为2组：治疗组（n=14）和对照组（n=14）。2组除实施相同的脓毒症综合治疗方案外，治疗组应用微量泵持续给予生理盐水＋尼莫地平注射液15μg／（kg·h）进行治疗，对照组给予相同剂量的生理盐水治疗。观察2组血浆肿瘤坏死因子－α（TNF—α）、白细胞介素6（IL-6）、C－反应蛋白（CRP）、前降钙素（PCT）、脑钠肽（BNP）、血钙、离子钙水平变化和血流动力学变化。结果①血流动力学指标明显改善（ABF、ACC、LVET、TSVR对照组治疗前后t值分别为3．93、3．37、3．75、7．02，治疗组治疗前后t值分别为6．46、4．98、6．29、4．60，P〈0．01或P〈0．05），平均动脉压无明显变化（P〉0．05）。与对照组比较，治疗组主动脉血流量（ABF）、左心室血流最大流速（ACC）、左心室射血分数时间（LVET）、外周血管阻力（TSVR）改善更为明显（t值分别为2．29、2．07、2．23、2．14，P〈0．01或P〈0．05）。②血浆TNF-α、IL-6、CRP浓度明显下降（TNF—α、IL-6、CRP对照组治疗前后t值分别为2．38、2．29、2．45，治疗组治疗前后t值分别为4．04、4．04、2．56，P〈0．01或P〈0．05）。PCT、BNP治疗组更明显（PCT、BNP治疗组治疗前后t值分别为5．45、2．44，P〈0．01或P〈0．05）。与对照组比较，治疗组TNF．仅、IL-6、CRP、PCT、BNP下降更为明显（t值分别为2．20、2．17、2．19、2．17、2．61，P〈0．01或P〈0．05）。③血浆总体钙和离子钙浓度轻度降低，治疗前后无明显变化（P〉0．05）。结论钙通道阻滞剂尼莫地平能降低脓毒症患者的血清炎性递质水平，抑制机体过度的炎症反应，抑制心肌细胞钙超载，改善心肌细胞功能，起到良好的细胞保护作用，从而提高了脓毒症的治愈率。
Objective To analyze the effect of nimodipine on prevention and treatment of patients with severe burn sepsis. Methods Twenty-eight cases were randomized into nimodipine treatment group （ n = 14） and routine group （n = 14）. Besides general clinical therapy scheme treatment, the treatment group was administrated with saline plus nimodipine （15μg/（ kg ·h））, while the routine group was given saline only. The Plasma concentration levels of total calcium （ Ca^2＋ ）, free calcium （ iCa^2 ＋） , C-reactive protein （CRP） , procalcitonin （ PCT ）, tunmor necrosis factor α （ TNF-α ） , brain natriuretic petide （BNP） and interleukin-6 （ IL-6 ） were measured. The hemodynamic indices of patients with severely burn sepsis were determined by transesophageal echo-Doppler device, hemodynamic indices including aortic blood flow （ABF） , left ventricle ejection time （ LVET）, max acceleration （ACC） , total systemic vascular resistance （ TSVR ） . Mean artery pressure （MAP） and heart rate （HR） were measured. Results ABF,ACC,LVET and TSVR were improved after therapy in the routine group（t =3.93,3.37, 3.75,7.02） （P 〈0. 01 or 0. 05）. ABF,ACC,LVET and TSVR were improved after therapy in the treatment group （ t = 6. 46,4. 98,6. 29,4. 60 ） （ P 〈 0. O1 or 0. 05 ）. ABF, ACC and LVET were increased after general clinical therapy scheme and was markedly increased in the treatment group （ t = 2. 29,2. 07,2. 23 ） （ P 〈 0. 01 - 0. 05 ）. TSVR was decreased after general clinical therapy scheme and was markedly decreased in the treatment group （t = 2. 14） （P 〈 0. 05 ）. Plasma TNF-α, IL-6 and CRP levels were decreased after therapy in the routine group （t = 2. 38,2. 29,2. 45 ） （ P 〈 0. 01 or 0. 05 ）. Plasma TNF-α, IL-6 and CRP levels were decreased after therapy in the treatment group （t =4. 04,4. 04,2. 56）（ P 〈 O. 01or 0. 05）. Plasma PCT and BNP levels were decreased in the treatment group （t =5.45,2. 44） （ P 〈 0. 01 or 0. 05 ）. TNF-α, IL-6, CRP, PCT and BNP were decreased after generalclinical therapy scheme and was markedly decreased in the treatment group （ t = 2. 2 0,2. 17 , 2. 19,2. 17 ,2. 61 ） （P 〈0. 01 or 0. 05）. Plasma Ca^2＋ and iCa^2＋ levels were decreased. However,MAP were increased in the two groups, although no difference was found between the two group （P 〉 0. 05 ）. Conclusions Early applying of calcium channel blockers （CCB） can markedly inhibit the degree of inflammatory medium in serum, thereby preventing the development of excessive inflammation response and subsequent multiple organ dysfunction syndrome associated with severely burned sepsis. It can effectively inhibit intracellular Ca^2＋ overload caused by myocadial infection injury, which may contribute to the effect of acupuncture in reducing myocardial injury and protecting myocardial performance and improving prognosis.
出处
《中国综合临床》
2010年第9期897-900,共4页
Clinical Medicine of China
基金
南京军区“十一五”医药卫生科研基金科技攻关课题（06251）
关键词
烧伤
钙通道阻滞剂
脓毒症
血流动力学
钙稳态
Burn
Calcium channel blockers
Sepsis
Hemodynamics
Calcium homeostasis
