The Clinical Observation Of Septic Myocardial Dysfunction And Experimental Research

BackgroundSeptic myocardial dysfunction in the pathogenesis of sepsis has a very important position. Septic patients prone to myocardial dysfunction and myocardial dysfunction, in turn, can increase the sepsis, or septic shock induced multiple organ dysfunction syndrome, sepsis, myocardial dysfunction is often late septic shock State can not ease one of the reasons continuing. Of septic myocardial dysfunction in patients with risk factors related to the investigation, identify vulnerable patients at high risk of myocardial dysfunction, sepsis, myocardial dysfunction for early diagnosis, early treatment is of great significance.Treatment is diagnosis and treatment patterns of Chinese medicine, Chinese medicine is the essence and the core. Elements of syndromes of TCM is the new direction of science, the current of sepsis syndromes on the elements of research is still very lacking. Sepsis Syndrome on the elements of research, summarized characteristics of sepsis syndromes, diagnosis and treatment options for sepsis, the formation of traditional Chinese medicine has an important significance.Complexity of the pathogenesis of sepsis, leading to myocardial dysfunction in sepsis way to diversify. Common view is that the pathogenesis of sepsis is not due to bacteria per se, but excessive activation of systemic inflammatory response caused by excessive release of inflammatory factors led to the formation of inflammatory Falls. Among them, tumor necrosis factor (TNF-α) is mainly composed of monocytes-macrophages stimulated by bacterial toxins and other important inflammatory cytokines produced, but also lead to inflammation cascade during sepsis, an important medium. Endothelin-1 (ET-1) is secreted by endothelial cells to maintain vascular tone vasoconstrictor peptide, and its main function is to maintain and vasodilator common vascular tone. Interleukin (IL-10) is produced by the body after being hit by anti-inflammatory factor. However, the production of inflammatory cytokines by a complex network of cascade control system, a variety of inflammation-promoting cytokines also have the effect of cross-cutting. Therefore, the key target for control of inflammation is to stop the expansion of the focus of myocardial injury in sepsis. p38MAPK is an important intracellular signal transduction protein, p38MAPK pathway is the regulation of inflammatory cytokine production and apoptosis is one important pathway, is considered to be sepsis, the development of one of the important bottlenecks in the sepsis of Myocardial dysfunction is important.Objectives1. Sepsis occurred in patients with sepsis related myocardial dysfunction to investigate the risk factors for the prevention and treatment of myocardial dysfunction in sepsis reference.2. TCM in patients with sepsis syndrome factors to investigate, summarize elements of the syndrome constitutes the characteristics of TCM interventions for the treatment of sepsis syndrome of basis.3. Inflammatory mediators and myocardial apoptosis, respectively, of Sini decoction on rat model of septic myocardial dysfunction in sepsis impact.Methods1. Through literature study, sepsis patients concluded myocardial dysfunction in sepsis may be risk factors. Subsequent cross-sectional survey of clinical research methods, included 86 patients with sepsis, which occurred in 28 cases of myocardial dysfunction (myocardial disorder group),58 patients without myocardial disorders (non-cardiac disorders group). When in the clinical investigation into and collect the appropriate physical and chemical indicators, specifically including serum CTnI, BNP, CKMB, APACHEⅡscore, past medical history, shock, blood lactate concentration, blood gas analysis, serum creatinine, bilirubin, serum albumin, blood Alanine aminotransferase and aspartate aminotransferase concentrations. Indicators of the above two groups were compared, of septic myocardial dysfunction in patients with risk factors2. Summary patients with sepsis syndromes common elements. Subsequent cross-sectional survey of clinical research methods, a total of 86 patients with sepsis Naruneike, of which 27 cases were normal in patients with sepsis, 35 patients with severe sepsis/septic shock patients,24 cases of sepsis Of MODS patients. When the inclusion factor for basic syndromes of traditional Chinese medicine to investigate, including the basic deficiency of Qi deficiency category, blood deficiency, yin deficiency, yang deficiency syndrome; basic empirical class phlegm, fire card, blood stasis, water Wetland permits, evidence organs. Also investigated the following:APACHEⅡscore. Of sepsis, different disease stages of sepsis, myocardial dysfunction in sepsis syndromes constitute a statistical analysis of elements, while elements of basic syndromes of traditional Chinese medicine, APACHE II score of the correlation.3. Animal experiments 70 male SD rats were randomly divided into 4 groups: control group (C group=10), sepsis group (M group) 20, low-dose group (SND, 3g native medicine/d, A Group) and high dose group (SND,6g native medicine /day, B group), n=20. To cecal ligation and puncture (Cecal ligation and puncture, CLP) sepsis model established, A, B 4-7 days after the modeling group were given low dose gavage SND,7 days after rat carotid artery in each group survived Blood collection and separation of the left ventricular myocardium. Myocardial microstructure changes, the use of double-antibody sandwich ELISA (Enzyme-linked immunosorbent assay, ELISA) method for detection of serum cardiac troponin I (cTnI), myocardial tumor necrosis factorα(TNF-α), brain Natriuretic peptide (BNP), interleukin-10 (IL-10), myocardial endothelin-1 (Endothelin-1, ET-1), TUNNEL Myocardial apoptosis was detected by Western blot (Western blot) method for detection of myocardial P38MAPKResults1. Analysis of risk factors showed that myocardial dysfunction in sepsis group's past history of coronary heart disease, the incidence of shock, respiratory failure rate, blood lactate concentration was higher than without myocardial damage occurring group. Logistic regression analysis showed previous history of coronary heart disease may affect the occurrence of myocardial dysfunction is a risk factor, OR is 9.193 [95%CI (2.077-40.682)].2. 86 cases of sepsis syndromes elements conducted a survey and found that the actual situation more common in mixed cards, accounting for 83.7%,9.3% purely empirical, acute deficiency of 7.0%. Deficiency syndrome in the basic elements, qi deficiency most frequently (73.7%), followed by Yang deficiency (35.9%), yin deficiency (21.8%). In the empirical elements of the basic syndrome, phlegm and heat syndrome occurs most frequently, both (86.3%), followed by stasis (37.5%), positive organs (25.0%). General sepsis patients with severe sepsis syndrome in patients with essential elements of traditional Chinese medicine constitutes no significant difference between patients with severe sepsis and MODS in patients with sepsis syndrome basic elements of traditional Chinese medicine suggest Qi deficiency, phlegm, clear heat syndrome Reduced Yang deficiency increased significantly, by statistical analysis significant differences (P<0.05). Compared with the general septic patients, sepsis patients with Yang deficiency of MODS was significantly increased, Qi deficiency, phlegm, heat syndrome, wet permits decreased by the difference statistically significant (P<0.05). Of 28 patients with myocardial damage in patients with sepsis syndromes elements, and found the actual situation more common mixed cards, accounting for 85.7%, simple empirical 3.6%, 10.7% of acute deficiency. Deficiency syndrome in the basic elements, qi deficiency most frequently (53.6%), followed by Yang deficiency (21.4%), yin deficiency (10.7%), blood deficiency (7.1%); in the empirical Elements of the basic syndrome, the highest frequency of occurrence of phlegm (71.4%), followed by hot card (60.9%), blood stasis syndrome (42.9%), wet card (14.3%). Elements of different syndromes were compared APACHEⅡscore and found that patients with sepsis Yang Deficiency APACHEⅡscore higher than those of patients with sepsis appeared Yang deficiency (P<0.05).3. Animal pathology of Sini decoction on myocardial effects of sepsis: Tip C light microscope the structure of myocardial muscle fibers arranged in close, no edema, congestion and exudation. M Structures of myocardial muscle fibers arranged in loose change there band vacuolization, interstitial edema, with congestion change, nuclear swelling than in normal group. A, B myocardial hyperemia and myocardial band vacuolization, nuclear swelling, interstitial edema, sepsis group compared with ease. The B group than the A group of myocardial lesions was reduced. TUNNEL prompt detection of myocardial apoptosis apoptosis rate M was significantly higher than C, and A, B group by the apoptosis rate of SND after treatment were significantly less than M, while the B group at the same time reduce the rate of apoptosis compared with A group More significantly, (P<0.05).4. SND decoction on plasma troponin sepsis CTnl, BNP M group cTnI, BNP levels compared with C group and A, B group was significantly higher (P=0.000); application of SND after the A group, B group cTnI, BNP levels were significantly lower than M, but still higher than the C group A, B no significant difference between the two groups, (P> 0.05).5. Sepsis, myocardial TNF-α, ET-1, IL-10 levels and the impact of SND M myocardial homogenate TNF-α, ET-1, IL-10 levels were significantly higher than C (P<0.05), after application of SND A group, B group TNF-a, ET-1, IL-10 Level was significantly lower than M (P<0.05), but lower than C group and S group was still higher (P<0.01). But A, B no significant difference between groups (P> 0.05).6. P38MAPK septic myocardial changes and the impact of SND P38MAPK gray M group was 0.769±0.043, compared with C group (0.091±0.067) was significantly higher (P<0.05), A group (0.631±0.074), B group (0.372±0.096), higher than those in M group level Reduce (P<0.05), and the B group than in the A group P38MAPK reduce the level (P<0.05).Conclusions1. Previous history of coronary heart disease may affect the occurrence of septic myocardial dysfunction is a risk factor, for the past history of coronary heart disease in patients with sepsis require close assessment of myocardial dysfunction, and hence early diagnosis and intervention.2. Sepsis patients, especially elderly patients with sepsis syndromes common to the actual situation permits inclusion in clinical intervention, in addition to "heat", you need to take into account "is false. " In severe sepsis/septic shock, sepsis stage of MODS, Yang deficiency increased the incidence of, and phlegm, heat syndrome is reduced in the treatment of attention on the need to strengthen the "Fu Yang " treatment, appropriate Reduce heat, expectorant and so on.3. Septic myocardial significant myocardial apoptosis associated with serum cTnI, BNP was significantly increased. Inflammatory cells secreted TNF-α, IL-10 and endothelial cells of ET-1 in septic rats significantly increased serum concentrations of the three closely related myocardial injury may be associated with sepsis. p38MAPK pathway of inflammation and apoptosis as an important signaling protein phosphorylation in the myocardium in sepsis significantly increased, indicating that p38MAPK pathway in septic myocardial dysfunction plays an important role. SND treatment can be significantly reduced degree of myocardial apoptosis in septic rats to reduce serum cTnI, BNP, TNF-α, IL-10, ET-1 levels, indicating that Sini decoction on myocardial dysfunction in sepsis has a protective Effect.