CAJ | 학술논문

目的观察参附注射液对急诊心肺复苏术(cardiopulmonary resuscitation,CPR)后患者的脏器功能的保护作用及预后的影响.方法采用前瞻性随机对照研究的方法,将2011年6月至2013年7月经复旦大学附属中山医院收治的124名急诊心肺复苏术患者,自主循环恢复超过24h,随机分为参附治疗组与常规治疗组,参附治疗组复苏成功后予以参附注射液以及急救治疗,常规治疗组给予除参附注射液之外的所有急救治疗.两组患者治疗至第14天,随访两组患者生存率、心肌钙蛋白(cardiac troponin,cTnT)、心房利纳肽(atrial natriuretic peptide,BNP)、血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)、血清门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、肌酐(creatinine,Cr)、C反应蛋白(C reactive protein,CRP)水平,氧合指数(PaO2/FiO2)以及格拉斯评分.统计学方法采用单因素ANOVA方差分析检验组内的样本差异和组间差异,以P ＜0.05为差异有统计学意义.结果 (1) 124例急诊心肺复苏术患者,参附治疗组68例,常规治疗组56例,随访14 d后参附治疗组存活47例,常规治疗组存活32例.(2)与常规治疗组比较,参附治疗组患者的cTnT显著降低(P =0.023),BNP显著降低(P =0.001);ALT显著降低(P=0.010),AST显著降低(P =0.001),sCr显著降低(P =0.008);CRP组显著降低(P=0.001),参附治疗组氧合指数(PO2/FiO2)较常规治疗组显著升高(P=0.001),格拉斯评显著升高(P=0.001).结论参附注射液可以减轻急诊心肺复苏术后患者重要脏器的缺血-再灌注损伤,保护心、脑、肺、肝、肾重要脏器的功能,可以改善急诊心肺复苏术后患者的预后.
목적 관찰삼부주사액대급진심폐복소술(cardiopulmonary resuscitation,CPR)후환자적장기공능적보호작용급예후적영향.방법 채용전첨성수궤대조연구적방법,장2011년6월지2013년7월경복단대학부속중산의원수치적124명급진심폐복소술환자,자주순배회복초과24h,수궤분위삼부치료조여상규치료조,삼부치료조복소성공후여이삼부주사액이급급구치료,상규치료조급여제삼부주사액지외적소유급구치료.량조환자치료지제14천,수방량조환자생존솔、심기개단백(cardiac troponin,cTnT)、심방리납태(atrial natriuretic peptide,BNP)、혈청병안산안기전이매(alanine aminotransferase,ALT)、혈청문동안산안기전이매(aspartate aminotransferase,AST)、기항(creatinine,Cr)、C반응단백(C reactive protein,CRP)수평,양합지수(PaO2/FiO2)이급격랍사평분.통계학방법채용단인소ANOVA방차분석검험조내적양본차이화조간차이,이P ＜0.05위차이유통계학의의.결과 (1) 124례급진심폐복소술환자,삼부치료조68례,상규치료조56례,수방14 d후삼부치료조존활47례,상규치료조존활32례.(2)여상규치료조비교,삼부치료조환자적cTnT현저강저(P =0.023),BNP현저강저(P =0.001);ALT현저강저(P=0.010),AST현저강저(P =0.001),sCr현저강저(P =0.008);CRP조현저강저(P=0.001),삼부치료조양합지수(PO2/FiO2)교상규치료조현저승고(P=0.001),격랍사평현저승고(P=0.001).결론 삼부주사액가이감경급진심폐복소술후환자중요장기적결혈-재관주손상,보호심、뇌、폐、간、신중요장기적공능,가이개선급진심폐복소술후환자적예후.
Objective To investigate the efficacy of Shenfu injection for the protection of multipleorgan function in patients after cardiopulmonary resuscitation (CPR) and evaluate the prognosis.Methods A prospective randomized and controlled study was carried out from June 2011 through July 2013.A total of 124 patients after CPR and spontaneous circulation restoration over 24 hours were randomly divided into two groups,namely the Shenfu treatment group and the routine therapy group.In the Shenfu treatment group,patients were administrated with Shenfu injection and essential emergency care.In the routine therapy group,patients were treated with all essential emergency care except Shenfu injection.The serum levels of cTnT,BNP,ALT,AST,sCr,CRP,oxygenation index and GCS scales of two groups were assayed and evaluated in the first day and the 14th day.Single factor ANOVA analysis was used to test the differences between two groups and P ＜ 0.05 was considered statistically significant.Results There were 68 patients in the Shenfu treatment group and 56 patients in the routine therapy group.In the 14th days,47 patients were survived in the Shenfu treatment group and 32 patients were survived in the routine therapy group.Compared with the routine therapy group,the level of cTnT,BNP,ALT,AST,sCr and CRP were significantly lower in the Shenfu treatment group (P values 0.023,0.001,0.01,0.001,0.008 and 0.001,respectively).The oxygenation index and GCS scales in the Shenfu treatment group were significantly higher than those in the routine therapy group (P values 0.001 and 0.001,respectively).Conclusion Shenfu injection could protect the function of heart,brain,lung,liver and kidney by attenuating the ischemia reperfusion injury in emergency patients after cardiopulmonary resuscitation improving the patient' s outcome.