摘要
目的 观察参麦注射液对心肺复苏（CPR）患者心肌损伤的影响,并探讨其可能的作用机制.方法 选择青岛市海慈医院2010年1月至2016年12月就诊的心搏呼吸骤停患者62例,将患者按简单随机方法分为常规治疗对照组30例和参麦治疗组32例.两组患者均给予CPR基本生命支持,同时给予复苏常用药物治疗;参麦治疗组在常规治疗基础上静脉滴注（静滴）参麦注射液100 mL,每日1次.治疗7 d进行疗效评价.于治疗前和治疗1、3、7 d取血测定两组患者心肌损伤标志物肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白T（cTnT）、N末端B型钠尿肽前体（NT-proBNP）水平,并观察两组室性心动过速、心室纤颤（室颤）及房室传导阻滞等心律失常发生率;采用床旁二维超声心动图测定两组患者左室射血分数（LVEF）、每搏量（SV）、心排血量（CO）.结果 常规治疗对照组治疗1 d CK-MB、cTnT表现为一过性升高,治疗3 d后较治疗前明显降低,治疗7 d达到最低水平;NT-proBNP治疗后持续降低,LVEF、SV、CO治疗后持续升高;参麦治疗组治疗后CK-MB、NT-proBNP持续降低,cTnT先升高后逐渐降低,治疗后7 d达到最低水平,LVEF、SV、CO先降低后升逐渐升高,治疗后7 d达到最高水平;参麦治疗组治疗后3、7 d CK-MB、cTnT、NT-proBNP均明显低于常规治疗对照组〔治疗3 d：CK-MB（U/L）为51±1比82±3,cTnT（μg/L）为2.5±0.3比3.9±0.2,NT-proBNP（ng/L）为5810±103比15965±152;治疗7 d：CK-MB（U/L）为27±2比56±3,cTnT（μg/L）为1.2±0.3比2.9±0.2,NT-proBNP（ng/L）为2834±123比4832±76〕,LVEF、SV、CO均明显高于常规治疗对照组〔治疗3 d：LVEF为0.47±0.03比0.45±0.02,SV（mL）为45±5比39±4,CO（L/min）为3.7±0.2比3.6±0.2;治疗7 d：LVEF为0.59±0.02比0.51±0.03,SV（mL）为55±4比45±2,CO（L/min）为5.3±0.3比4.6±0.4,均P＜0.05〕.两组患者CPR后均有心律失常发生,参麦治疗组治疗1 d心律失常发生率与治疗前比较差异均无统计学意义（均P＞0.05）,治疗3、7 d后心律失常发生率均较治疗前明显下降,治疗7 d达最低水平,且参麦治疗组治疗后降低程度较对照组更显著〔室性心动过速：9.4%（3/32）比20.0%（6/30）,室颤：9.4%（3/32）比20.0%（6/30）,房室传导阻滞：18.8%（6/32）比36.7%（11/30）,均P＜0.05〕.结论 参麦注射液对CPR后患者心肌损伤有一定保护作用,其机制可能与降低CK-MB、cTnT、NT-proBNP水平,进而改善LVEF、SV、CO有关.
Objective To observe the curative effect of Shenmai injection on patients with myocardial injury after cardiopulmonary resuscitation （CPR） and to explore its possible mechanism.Methods Sixty-two patients with cardiac arrest and respiratory arrest admitted to Qingdao Hiser Hospital from January 2010 to December 2016 were enrolled, they were randomly divided into a conventional therapy control group （30 cases） and a Shenmai treatment group （32 cases） and both groups were also treated by conventional treatment. The patients in the two groups were given basic life support of CPR and its commonly used drugs simultaneously. In Shenmai treatment group, the patients were additionally infused intravenously with 100 mL of Shenmai injection once per day. The therapeutic effect was evaluated after treatment for 7 days. On the day before treatment and 1, 3 and 7 days after treatment, the patient＆#39;s blood was collected to determine the levels of myocardial injury landmarks, serum creatine kinase isoenzyme （CK-MB）, cardiac troponin T （cTnT） and N-terminal B-type natriuretic peptide （NT-proBNP）, and the incidences of arrhythmia of ventricular tachycardia, ventricular fibrillation （VF） and atrioventricular block were observed in the two groups; the left ventricular ejection fraction （LVEF）, stroke volume （SV） and cardiac output （CO） were measured at bedside by two-dimensional echocardiography for the patients of two groups.Results In conventional therapy control group, the levels of CK-MB, cTnT showed a temporary increase after 1 day of treatment, after 3 days of treatment, CK-MB and cTnT were significantly lower than those before treatment, and reached the lowest levels after 7 days of treatment; the level of NT-proBNP after treatment showed a continuous decrease, the levels of LVEF, SV, CO were persistently increased after treatment; in Shenmai treatment group, the levels of CK-MB, NT-proBNP were decreased continuously after treatment, cTnT was firstly increase and then decrease, and reached to the lowest revels after 7 days of treatment while the levels of LVEF, SV and CO were firstly decreased and then increased gradually, and reached to the highest levels after 7 days of treatment; compared with those of conventional therapy control group, the levels of CK-MB, cTnT, NT-proBNP in Shenmai treatment group were significantly lower after 3 and 7 days of treatment [3 days of treatment： CK-MB （U/L）was 51±1 vs. 82±3, cTnT （μg/L） was 2.5±0.3 vs. 3.9±0.2, NT-proBNP （ng/L） was 5 810±103 vs. 15 965±152;7 days of treatment： CK-MB （U/L） was 27±2 vs. 56±3, cTnT （μg/L） was 1.2±0.3 vs. 2.9±0.2, NT-proBNP （ng/L） was 2 834±123 vs. 4 832±76], while LVEF, SV and CO were significantly higher than those in conventional therapy control group [3 days of treatment： LVEF was 0.47±0.03 vs. 0.45±0.02, SV （mL） was 45±5 vs. 39±4, CO （L/min） was 3.7±0.2 vs. 3.6±0.2; 7 days of treatment： LVEF was 0.59±0.02 vs. 0.51±0.03, SV （mL） was 55±4 vs. 45±2, CO （L/min） was 5.3±0.3 vs. 4.6±0.4, all P 〈 0.05]. After CPR, arrhythmia developed in the patients of two groups, and compared with that before treatment, there was no statistical significant difference in the incidence of arrhythmia after 1 day of treatment in Shenmai treatment group （all P 〉 0.05）; the incidence of arrhythmia was decreased significantly after 3 and 7 days of treatment compared with those before treatment, reached to the lowest level on the 7th day of treatment, and the degree of decrease of incidence of arrhythmia in Shenmai treatment group was more obvious than those of the conventional therapy control group [ventricular tachycardia： 9.4% （3/32） vs. 20.0% （6/30）, VF： 9.4% （3/32） vs. 20.0 % （6/30）, atrial ventricular block： 18.8% （6/32） vs. 36.7% （11/30）, all P 〈 0.05]. Conclusions Shenmai injection has certain protective effect on injured myocardium in patients undergoing CPR, the mechanism is possibly related to reducing the levels of CK-MB,cTnT, NT-proBNP and further improving the LVEF, SV and CO.
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2017年第6期598-601,621,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
山东省青岛市医药科研指导计划（2007-WSZD-068）
关键词
心肺复苏
心肌损伤
缺血/再灌注
参麦注射液
Cardiopulmonary resuscitation
Myocardial injury
Ischemia/reperfusion
Shenmai injection
