CAJ | 학술논문

目的探讨生脉注射液持续静脉泵入治疗急性冠脉综合征（ACS）合并心源性休克的临床疗效。方法选择2005年1月至2011年3月本院收治的ACS 合并心源性休克患者33例为治疗组，同期住院ACS 患者32例为对照组，将治疗组再按不同中医证型分为阴虚型（15例）、气虚型（11例）、血瘀型（7例）。两组均给予西医常规治疗，对照组在西医常规治疗基础上给予生脉注射液30～60 mL 静脉滴注（静滴），每日1次；治疗组给予生脉注射液10～100 mL/h 微量泵持续静滴，血压恢复正常后生脉注射液5 mL/h 微量泵持续静脉注射，连续5～7 d。观察两组患者治疗后的临床疗效、血压、心率、临床症状改善情况及治疗组不同中医证型患者平均动脉压（MAP）的变化。结果治疗组显效率〔69.7%（23例）比46.9%（15例）〕、总有效率〔90.9%（30例）比62.5%（20例）〕均明显高于对照组（均P＜0.05）。两组治疗前后血压和心率比较差异均无统计学意义（均 P＞0.05）。治疗后48 h 治疗组临床症状较对照组明显改善〔胸痛：2例（6.1%）比10例（31.3%），汗出：3例（9.1%）比13例（40.6%），气短：4例（12.1%）比12例（37.5%），均P＜0.05；心悸：5例（15.2%）比9例（28.1%），恶心：3例（9.1%）比4例（12.5%），但P＞0.05〕，治疗组阴虚型患者的MAP（mm Hg，1 mm Hg＝0.133 kPa）升高较气虚型、血瘀型明显（105.00±8.53比91.00±9.53和89.00±3.53，均P＜0.05）。结论持续生脉注射液静脉注射治疗ACS 合并心源性休克患者疗效显著。
목적탐토생맥주사액지속정맥빙입치료급성관맥종합정（ACS）합병심원성휴극적림상료효。방법선택2005년1월지2011년3월본원수치적ACS 합병심원성휴극환자33례위치료조，동기주원ACS 환자32례위대조조，장치료조재안불동중의증형분위음허형（15례）、기허형（11례）、혈어형（7례）。량조균급여서의상규치료，대조조재서의상규치료기출상급여생맥주사액30～60 mL 정맥적주（정적），매일1차；치료조급여생맥주사액10～100 mL/h 미량빙지속정적，혈압회복정상후생맥주사액5 mL/h 미량빙지속정맥주사，련속5～7 d。관찰량조환자치료후적림상료효、혈압、심솔、림상증상개선정황급치료조불동중의증형환자평균동맥압（MAP）적변화。결과치료조현효솔〔69.7%（23례）비46.9%（15례）〕、총유효솔〔90.9%（30례）비62.5%（20례）〕균명현고우대조조（균P＜0.05）。량조치료전후혈압화심솔비교차이균무통계학의의（균 P＞0.05）。치료후48 h 치료조림상증상교대조조명현개선〔흉통：2례（6.1%）비10례（31.3%），한출：3례（9.1%）비13례（40.6%），기단：4례（12.1%）비12례（37.5%），균P＜0.05；심계：5례（15.2%）비9례（28.1%），악심：3례（9.1%）비4례（12.5%），단P＞0.05〕，치료조음허형환자적MAP（mm Hg，1 mm Hg＝0.133 kPa）승고교기허형、혈어형명현（105.00±8.53비91.00±9.53화89.00±3.53，균P＜0.05）。결론지속생맥주사액정맥주사치료ACS 합병심원성휴극환자료효현저。
Objective To explore the clinical efficacy of continuous intravenous pump of Shengmai injection for treatment of patients with acute coronary syndrome(ACS)combined with cardiogenic shock. Methods In the period from January 2005 to March 2011,33 hospitalized patients with ACS complicated by cardiogenic shock were selected in the treatment group,and in the same period,32 in-patients with ACS were enrolled in the control group, According to traditional Chinese medicine(TCM)syndrome type,the treatment group was subdivided into "Yin xu"type(Yin deficiency,15 cases),"Qi xu" type(Qi deficiency,11 cases),"Xue yu" type(blood stasis,7 cases). Conventional western medicine treatment was given to the two groups,besides,Shengmai injection in 30-60 mL intravenous drip,once a day was applied in the control group,while in the treatment group,Shengmai injection in 10-100 mL/h trace pump continuous intravenous infusion was given,after the blood pressure returned to normal,the infusion was changed to 5 mL/h trace pump continuous intravenous injection for consecutive 5-7 days. After treatment, the changes of clinical efficacy,blood pressure,heart rate ,improvement of clinical symptoms were observed in two groups,and the changes of mean arterial pressure(MAP)in cases with different syndromes in treatment group were also investigated. Results The rates of the significant therapeutic effect and total effect in the treatment group were obviously higher than those in the control group〔significant effect:69.7%(23 cases)vs. 46.9%(15 cases);the total efficacy:90.9%(30 cases)vs. 62.5%(20 cases),both P<0.05〕. The comparisons of blood pressure and heart rate before and after treatment in the two groups were not significant(all P>0.05). After 48 hours of treatment in the two groups,the clinical symptoms were all improved〔chest pain:2 cases(6.1%)vs. 10 cases(31.3%),sweating:3 cases(9.1%)vs. 13 cases(40.6%),shortness of breath:4 cases(12.1%)vs. 12 cases(37.5%),all P<0.05;heart palpitations:5 cases(15.2%)vs. 9 cases(28.1%),nausea:3 cases(9.1%)vs. 4 cases(12.5%),both P>0.05〕. In treatment group,the increase of MAP in patients with"Yin xu"type(mm Hg,1 mm Hg=0.133 kPa)was higher than that in patients with "Qi xu" type and "Xue xu" type(105.00±8.53 vs. 91.00±9.53,89.00±3.53,both P<0.05). Conclusion Continuous intravenous injection of Shengmai injection has significant therapeutic effect for treatment of patients with ACS combined with cardiogenic shock.