目的 探讨血必净注射液与重组人脑利钠肽联合使用在治疗脓毒症心肌病方面的临床效果。方法 纳入2022年8月—2023年8月在河北省中医院诊治的脓毒症心肌病患者60例，随机分为对照组和治疗组，每组各30例。对照组静脉泵入注射用重组人脑利钠肽，初始静脉推注1.5 μg/kg负荷剂量，随后按照0.007 5 μg/(kg∙min)静脉连续泵入治疗。治疗组患者在对照组基础上静脉滴注血必净注射液，50 mL加入100 mL生理盐水，2次/d。两组患者均接受为期7 d的治疗。观察两组患者临床疗效，比较治疗前后两组患者格拉斯哥昏迷评分（GCS）、器官功能衰竭（SOFA）评分、呼吸机辅助时间、ICU住院时间、28 d病死率，及高敏心肌肌钙蛋白T（hs-cTnT）、N末端脑钠肽前体（NT-proBNP）、肌酸激酶同工酶（CK-MB）、C反应蛋白（CRP）、白细胞介素-6（IL-6）和白细胞介素-8（IL-8）水平。结果 治疗后，对照组与治疗组的临床总有效率分别为63.33%、86.67%，两组比较差异具有统计学意义（P＜0.05）。治疗后，两组GCS评分比治疗前明显升高，而SOFA评分明显降低（P＜0.05），且治疗组GCS评分和SOFA评分均显著优于对照组（P＜0.05）。治疗后，治疗组脓毒症心肌病患者呼吸机辅助时间、ICU住院时间和28 d病死率均明显低于对照组（P＜0.05）。治疗后，两组hs-cTnT、NT-proBNP、CK-MB、CRP、IL-6和IL-8水平比同组治疗前明显降低（P＜0.05），且治疗组这些血清因子水平显著低于对照组（P＜0.05）。结论 血必净注射液联合重组人脑利钠肽治疗脓毒症心肌病疗效显著，不仅能够显著改善患者的病情严重程度并缩短呼吸机辅助和ICU住院时间，而且减轻了患者的心肌损伤和体内炎症反应水平，从而降低了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

河北省中医药管理局科研计划项目（2022062）；政府资助临床医学优秀人才培养项目（ZF2024158）