目的 研究生脉注射液治疗急性心肌梗死后心源性休克的临床疗效。方法 选取2015年6月-2016年8月十堰市太和医院治疗的急性心肌梗死后心源性休克患者164例，随机分为对照组和治疗组，每组各82例，对照组给予常规治疗，治疗组在对照组的基础上静脉滴注生脉注射液，60 mL加入5%葡萄糖溶液250~500 mL，1次/d。两组均连续治疗7 d。治疗后，观察两组患者临床疗效，同时比较血清心肌肌钙蛋白I（cTnI）、钙调蛋白（CaM）及其基因表达，心功能指标左心室内压最大上升速率（dp/dt_max）、左心室内压最大下降速率（-dp/dt_max）、左室射血分数（LVEF）、舒张末期室间隔厚度（IVST）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、心脏指数（CI），及肺毛细血管楔压（PCWP）、心率（HR）、收缩压（SBP）、舒张压（DBP）、脉压（PP）和尿量（UV）的变化。结果 治疗后，对照组和治疗组总有效率分别为60.97%和74.39%，两组总有效率比较差异有统计学意义（P<0.05）。两组cTnI、CaM、cTnI-mRNA和CaMKII-mRNA均较治疗前显著降低，同组治疗前后差异有统计学意义（P<0.05），且治疗组上述指标降低更明显，两组比较差异有统计学意义（P<0.05）。两组±dp/dt_max、LVEF和CI均升高、LVEDD增大，IVST和LVESD均缩小（P<0.05），且治疗组上述指标改善更明显（P<0.05）。两组患者PCWP和HR均降低，SBP和DBP均升高，PP增大，UV增多（P<0.05），且治疗组上述指标改善更明显（P<0.05）。治疗组并发症中室间隔穿孔、急性肾衰竭和心律失常和死亡率明显低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 生脉注射液治疗急性心肌梗死后心源性休克疗效显著，纠正急性心肌梗死时心肌“钙超载”现象，明显增强心脏泵血功能，具有一定的临床推广应用价值。

Objective To study the clinical effect of Shengmai Injection in treatment of cardiogenic shock (CS) after acute myocardial infarction (AMI), in order to provide the theoretical basis for clinical use. Methods Patients (164 cases) with cardiogenic shock after acute myocardial infarction in Shiyan Taihe Hospital from June 2015 to August 2016 were randomly divided into control and treatment groups, and each group had 82 cases. Patients in the control group were given conventional therapy. Patients in the treatment group were iv administered with Shengmai Injection on the basis of the control group, 60 mL added into 5% glucose injection 250-500 mL, once daily. Patients in two groups were treated for 7 d. After treatment, the efficacy was evaluated, and serum cardiac troponin I (cTnI), calmodulin (CaM) and the gene expression, cardiac function indexes left ventricular maximal rise rate (dp/dt_max), left ventricular maximal fall rate (-dp/dt_max), left ventricular ejection fraction (LVEF), interventricular septum thick (IVST), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and the amount of urine (UV) were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 60.97% and 74.39%, respectively, and there were differences between two groups (P<0.05). After treatment, cTnI, CaM, cTnI-Mrna, and CaMKII-mRNA in two groups were decreased, and there were significant differences between the same groups before and after treatment (P<0.05). And these indexes in treatment group were decreased more than those in the control group with significant differences (P<0.05). ±dp/dt_max, LVEF, CI, and LVEDD were increased, while IVST and LVESD were decreased (P<0.05). And these indexes in treatment group were improved more significantly than those in the control group (P<0.05). PCWP and HR were decreased, while SBP, DBP, PP, and UV were increased with significant differences (P<0.05). And these indexes in treatment group were improved more significantly than those in the control group (P<0.05). Ventricular septal rupture, acute renal failure, arrhythmia, and mortality rate in the treatment group were lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Shengmai Injection has a significant clinical efficacy in treatment of cardiogenic shock after acute myocardial infarction, can correct the myocardial calcium overload of AMI, and increase heart pump function obviously, which has a certain clinical application value.

湖北省教育厅教育科学“十二五”规划课题（2014B095）