参附注射液联合亚低温治疗心脏骤停患者的临床效果

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摘要目的观察参附注射液联合亚低温治疗心脏骤停（CA）患者的临床效果。方法选取2015年1月～2018年12月山东省青岛市海慈医疗集团收治的138例CA患者作为研究对象，按照随机数字表法将其分为对照组和观察组，每组69例。对照组给予亚低温（32～34℃）治疗，观察组在对照组基础之上，再静脉输注100 mL的参附注射液。心肺复苏后30 min、2 h、12 h和24 h采用酶联免疫法检测超氧岐化酶（SOD）、一氧化氮（NO）、丙二醛（MDA）、神经元特异性烯醇化酶（NSE）、人S100B蛋白（S-100B）；CA 12、24、48、72 h检测患者脑氧代谢指标，包括动静脉血氧含量差（Ca-jvO2）、颈静脉球部血氧饱和度（SjvO2）和脑氧摄取率（CERO2）；采用格拉斯哥昏迷量表（GCS）评估患者的昏迷状态；统计复苏有效率和病死率。结果与复苏后30 min比较，对照组复苏2、12、24 h，SOD和NO水平明显下降，MDA水平明显升高，差异均有统计学意义（均P ＜ 0.05）。与复苏后30 min比较，观察组复苏2、12、24 h，SOD水平明显下降，NO和MDA水平明显升高，差异均有统计学意义（均P ＜ 0.05）。与复苏后30 min比较，两组患者复苏后2、12、24 h，NSE和S-100B水平均明显升高，差异均有统计学意义（均P ＜ 0.05）。复苏后2、12、24 h观察组SOD和NO水平明显高于对照组，MDA、NSE和S-100B水平明显低于对照组，差异均有统计学意义（均P ＜ 0.05）。与CA 12 h比较，两组患者CA 24、48、72 h，SjvO2水平和GCS评分明显升高，而Ca-jvO2水平明显降低，差异均有统计学意义（均P ＜ 0.05）。两组患者CA 24 h CERO2水平明显高于12 h，CA 48、72 h CERO2水平明显低于12 h，差异均有统计学意义（均P ＜ 0.05）。CA 48、78 h观察组Ca-jvO2、CERO2水平和GCS评分明显高于对照组，而SjvO2水平明显低于对照组，差异均有统计学意义（均P ＜ 0.05）。观察组治疗有效率明显高于对照组，而病死率明显低于对照组，差异均有统计学意义（均P ＜ 0.05）。结论参附注射液联合亚低温治疗对CA患者心肺复苏心肌组织和脑组织的保护作用明显，能够改善预后。

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	王君何亚萍安朋朋邱志鹏鲁召欣张森张毅宋永欣

关键词 ：心脏骤停, 心肺复苏, 参附注射液, 氧自由基代谢

Abstract：Objective To observe the clinical effect of Shenfu Injection combined with mild hypothermia in the treatment of patients with cardiac arrest (CA). Methods A total of 138 patients with CA who admitted to Qingdao Haici Medical Group, Shandong Province from January 2015 to December 2018 were selected as research objects, and they were randomly divided into control group and observation group according to the random number table method, with 69 patients in each group. The control group was treated with mild hypothermia (32 - 34℃), and the observation group was given 100 mL Shenfu Injection intravenously on the basis of the control group. Superoxide dismutase (SOD), nitric oxide (NO), malondialdehyde (MDA), neuron specific enolase (NSE), human S100B protein (S-100B) were detected by enzyme-linked immunoassay at 30 min, 2 h, 12 h and 24 h after cardiopulmonary resuscitation. Cerebral oxygen metabolism indexes of patients were detected at 12, 24, 48 and 72 h after CA respectively, including arteriovenous oxygen content difference (Ca-jvO2), jugular bulb blood oxygen saturation (SjvO2) and cerebral oxygen uptake rate (CERO2). The Glasgow coma scale (GCS) was used to assess the coma status of the patients. The recovery efficiency and case fatality rate were calculated. Results Compared with 30 min after resuscitation, the levels of SOD and NO significantly decreased and the level of MDA significantly increased in the control group at 2, 12 and 24 h after resuscitation, with statistically significant differences (all P ＜ 0.05). Compared with 30 min after resuscitation, the level of SOD significantly decreased and the levels of NO and MDA significantly increased in the observation group at 2, 12 and 24 h after resuscitation, with statistically significant differences (all P ＜ 0.05). Compared with 30 min after resuscitation, the levels of NSE and S-100B in the two groups were significantly increased at 2, 12 and 24 h after resuscitation, and the differences were statistically significant (all P ＜ 0.05). At 2, 12 and 24 h after resuscitation, the levels of SOD and NO in the observation group were significantly higher than those in the control group, while the levels of MDA, NSE and S-100B in the observation group were significantly lower than those in the control group, with statistically significant differences (all P ＜ 0.05). Compared with CA at 12 h, the level of SjvO2 and GCS score were significantly increased at 24, 48 and 72 h after CA, while the level of Ca-jvO2 were significantly decreased in both groups, with statistically significant differences (all P ＜ 0.05). The level of CERO2 at 24 h after CA was significantly higher than that at 12 h, and that at 48 and 72 h after CA was significantly lower than that at 12 h. with statistically significant differences (all P ＜ 0.05). The levels of Ca-jvO2, CERO2 and GCS score in the observation group at 48 and 78 h after CA were significantly higher than those in the control group, while the level of SjvO2 were significantly lower than those in the control group, with statistically significant differences (all P ＜ 0.05). The effective rate of treatment in the observation group was significantly higher than that in the control group, while the case fatality rate was significantly lower than that in the control group, with statistically significant differences (all P ＜ 0.05). Conclusion Shenfu Injection combined with mild hypothermia has a significant protective effect on cardiopulmonary resuscitation myocardial tissue and brain tissue in patients with CA, and can significantly improve the prognosis.

Key words： Cardiac arrest Cardiopulmonary resuscitation Shenfu Injection Oxygen free radical metabolism

基金资助:山东省青岛市医药科研指导计划项目（2013-WSZD046）。

作者简介: 王君（1969.10-），女，硕士，副主任医师；研究方向：急救危重病。

引用本文:

王君何亚萍安朋朋邱志鹏鲁召欣张森张毅宋永欣. 参附注射液联合亚低温治疗心脏骤停患者的临床效果[J]. 中国医药导报, 2020, 17(17): 71-74.
WANG Jun HE Yaping AN Pengpeng QIU Zhipeng LU Zhaoxin ZHANG Sen ZHANG Yi SONG Yongxin. Clinical effect of Shenfu Injection combined with mild hypothermia in the treatment of patients with cardiac arrest. 中国医药导报, 2020, 17(17): 71-74.

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