中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
1期
34-37
,共4页
乌司他丁%纳洛酮%急性心肌梗死%心源性休克
烏司他丁%納洛酮%急性心肌梗死%心源性休剋
오사타정%납락동%급성심기경사%심원성휴극
Ulinastatin%Naloxone%Acute myocardial infarction%Cardiogenic shock
目的 观察乌司他丁联合纳洛酮对急性心肌梗死(AMI)合并心源性休克患者的临床治疗效果.方法 80例AMI合并心源性休克患者随机分为常规治疗组19例、乌司他丁组20例、纳洛酮组21例、乌司他丁联合纳洛酮组20例.检测患者入院及治疗1周后心肌肌钙蛋白I (cTnI)、脑钠肽(BNP)、肿瘤坏死因子-α (TNF-α)、白细胞介素-6(IL-6)的浓度；同时观察休克恢复时间、住院天数及28 d病死率.比较各组患者上述指标间的差异.结果 4组患者治疗后cTnI[常规治疗组(2.06±0.15) ng/L、乌司他丁组(1.59±0.16) ng/L、纳洛酮组(1.97±0.14) ng/L、乌司他丁联合纳洛酮组(1.04±0.17)ng/L]、BNP[常规治疗组(261.07±71.43) ng/L、乌司他丁组(203.46±65.73) ng/L、纳洛酮组(252.96±68.85) ng/L、乌司他丁联合纳洛酮组(143.21±56.94) ng/L]、TNF-α[常规治疗组(31.21±12.32) ng/L、乌司他丁组(20.39±11.08) ng/L、纳洛酮组(28.98±11.76) ng/L、乌司他丁联合纳洛酮组(13.42±8.93)ng/L]、IL-6[常规治疗组(80.46±27.15) ng/L、乌司他丁组(59.84±20.72) ng/L、纳洛酮组(76.15±26.45)ng/L、乌司他丁联合纳洛酮组(37.58±11.14) ng/L]的浓度较治疗前均下降(P均＜0.01),其中乌司他丁联合纳洛酮组各指标下降幅度大于常规治疗组、乌司他丁组和纳洛酮组(P均＜0.01).乌司他丁联合纳洛酮组休克恢复时间(7.16±1.52)d、住院时间(15.03±3.23)d及28 d病死率(41.62％)明显低于乌司他丁组[(8.05±1.81)d、(18.93±3.97)d、50.74％]、纳洛酮组[(8.74±1.98)d、(19.21±3.94)d、52.31％]和常规治疗组[(11.43±2.40)d、(22.64±4.18)d、61.20％],差异均有统计学意义(P均＜0.01).结论 乌司他丁联合纳洛酮能有效减轻AMI合并心源性休克患者的心肌损伤及炎症反应,促进循环功能恢复并改善其预后.
目的 觀察烏司他丁聯閤納洛酮對急性心肌梗死(AMI)閤併心源性休剋患者的臨床治療效果.方法 80例AMI閤併心源性休剋患者隨機分為常規治療組19例、烏司他丁組20例、納洛酮組21例、烏司他丁聯閤納洛酮組20例.檢測患者入院及治療1週後心肌肌鈣蛋白I (cTnI)、腦鈉肽(BNP)、腫瘤壞死因子-α (TNF-α)、白細胞介素-6(IL-6)的濃度；同時觀察休剋恢複時間、住院天數及28 d病死率.比較各組患者上述指標間的差異.結果 4組患者治療後cTnI[常規治療組(2.06±0.15) ng/L、烏司他丁組(1.59±0.16) ng/L、納洛酮組(1.97±0.14) ng/L、烏司他丁聯閤納洛酮組(1.04±0.17)ng/L]、BNP[常規治療組(261.07±71.43) ng/L、烏司他丁組(203.46±65.73) ng/L、納洛酮組(252.96±68.85) ng/L、烏司他丁聯閤納洛酮組(143.21±56.94) ng/L]、TNF-α[常規治療組(31.21±12.32) ng/L、烏司他丁組(20.39±11.08) ng/L、納洛酮組(28.98±11.76) ng/L、烏司他丁聯閤納洛酮組(13.42±8.93)ng/L]、IL-6[常規治療組(80.46±27.15) ng/L、烏司他丁組(59.84±20.72) ng/L、納洛酮組(76.15±26.45)ng/L、烏司他丁聯閤納洛酮組(37.58±11.14) ng/L]的濃度較治療前均下降(P均＜0.01),其中烏司他丁聯閤納洛酮組各指標下降幅度大于常規治療組、烏司他丁組和納洛酮組(P均＜0.01).烏司他丁聯閤納洛酮組休剋恢複時間(7.16±1.52)d、住院時間(15.03±3.23)d及28 d病死率(41.62％)明顯低于烏司他丁組[(8.05±1.81)d、(18.93±3.97)d、50.74％]、納洛酮組[(8.74±1.98)d、(19.21±3.94)d、52.31％]和常規治療組[(11.43±2.40)d、(22.64±4.18)d、61.20％],差異均有統計學意義(P均＜0.01).結論 烏司他丁聯閤納洛酮能有效減輕AMI閤併心源性休剋患者的心肌損傷及炎癥反應,促進循環功能恢複併改善其預後.
목적 관찰오사타정연합납락동대급성심기경사(AMI)합병심원성휴극환자적림상치료효과.방법 80례AMI합병심원성휴극환자수궤분위상규치료조19례、오사타정조20례、납락동조21례、오사타정연합납락동조20례.검측환자입원급치료1주후심기기개단백I (cTnI)、뇌납태(BNP)、종류배사인자-α (TNF-α)、백세포개소-6(IL-6)적농도；동시관찰휴극회복시간、주원천수급28 d병사솔.비교각조환자상술지표간적차이.결과 4조환자치료후cTnI[상규치료조(2.06±0.15) ng/L、오사타정조(1.59±0.16) ng/L、납락동조(1.97±0.14) ng/L、오사타정연합납락동조(1.04±0.17)ng/L]、BNP[상규치료조(261.07±71.43) ng/L、오사타정조(203.46±65.73) ng/L、납락동조(252.96±68.85) ng/L、오사타정연합납락동조(143.21±56.94) ng/L]、TNF-α[상규치료조(31.21±12.32) ng/L、오사타정조(20.39±11.08) ng/L、납락동조(28.98±11.76) ng/L、오사타정연합납락동조(13.42±8.93)ng/L]、IL-6[상규치료조(80.46±27.15) ng/L、오사타정조(59.84±20.72) ng/L、납락동조(76.15±26.45)ng/L、오사타정연합납락동조(37.58±11.14) ng/L]적농도교치료전균하강(P균＜0.01),기중오사타정연합납락동조각지표하강폭도대우상규치료조、오사타정조화납락동조(P균＜0.01).오사타정연합납락동조휴극회복시간(7.16±1.52)d、주원시간(15.03±3.23)d급28 d병사솔(41.62％)명현저우오사타정조[(8.05±1.81)d、(18.93±3.97)d、50.74％]、납락동조[(8.74±1.98)d、(19.21±3.94)d、52.31％]화상규치료조[(11.43±2.40)d、(22.64±4.18)d、61.20％],차이균유통계학의의(P균＜0.01).결론 오사타정연합납락동능유효감경AMI합병심원성휴극환자적심기손상급염증반응,촉진순배공능회복병개선기예후.
Objective To study clinical efficacy of ulinastatin combined with naloxone in patients with cardiogenic shock(CS) after acute myocardial infarction (AMI).Methods Eighty patients with CS after AMI were randomly divided into routine treatment group (n =19),ulinastatin group (n =20),naloxone group (n =21) and ulinastatin combined with naloxone group (n =20).The levels of serum cardiac troponin I (cTnI),brain natriuretic peptide(BNP),tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6)were measured before and a week after treatment.In the meantime,recovery time of shock,the average hospitalization days and 28-day mortality rate were recorded.Results After the treatment,the levels of serum cTnI,BNP,TNF-α and IL-6decreased in all groups(P ＜ 0.01),and there was significant difference on the decreasing degree of cTnI,BNP,TNF-α and IL-6 in ulinastatin combined with naloxone group when compared with those in routine treatment group,ulinastatin group and naloxone group(cTnI:(1.04 ± 0.17) ng/L vs.(2.06 ± 0.15) ng/L,(1.59 ± 0.16)ng/L,(1.97 ± 0.14) ng/L; BNP:(143.21-56.94) ng/L vs.(261.07 ± 71.43) ng/L,(203.46 ± 65.73) ng/L,(252.96 ± 68.85) ng/L; TNF-α:(13.42 ± 8.93) ng/L vs.(31.21 ± 12.32) ng/L,(20.39 ± 11.08) ng/L,(28.98 ± 11.76) ng/L ; IL-6:(37.58 ± 11.14) ng/L vs.(80.46 ± 27.15) ng/L,(59.84 ± 20.72) ng/L,(76.15 ±26.45) ng/L; P ＜ 0.01).The recovery time of shock,the average hospitalization days and 28-day mortality rate in ulinastatin combined with naloxone group were significantly lower than those in routine treatment group,ulinastatin group and naloxone group(recovery time of shock:(7.16 ± 1.52) d vs.(11.43 ± 2.40) d,(8.05 ±1.81)d,(8.74 ± 1.98)d;the average hospitalization days:(15.03 ±3.23)d vs.(22.64 ±4.18)d,(18.93 ±3.97)d,(19.21 ±3.94)d ;28-day mortality rate:(41.62％ vs.61.20％,50.74％,52.31％ ; P ＜0.01)).Conclusion The application of ulinastatin combined with naloxone can effectively inhibit the cardiac injury and inflammatory response,promote the recovery of circulation function and improve prognosis in patients with CS after AMI.
