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目的 探讨参附注射液改善心肺复后患者的疗效。方法 选取2015年1月—2016年6月天津中医药大学第一附属医院收治的心脏骤停复苏成功患者57例,按照随机数表法将患者分为对照组(28例)和治疗组(29例)。对照组给予机械通气、心脏除颤及肾上腺素、多巴胺、盐酸胺碘酮、碳酸氢钠等抢救治疗,恢复自主心搏后积极维持循环、亚低温治疗。治疗组在对照组基础上于抢救早期静脉滴注参附注射液,100 mL加入到5%葡萄糖250 mL中,1次/d。两组均连续治疗1周。比较两组的心脏指数、血乳酸、格拉斯哥昏迷(GCS)评分和28 d死亡率。结果 治疗后,两组24、48、72 h心脏指数明显高于1 h时,而12、24、48、72 h血乳酸明显低于1 h时,同组治疗前后比较差异有统计学意义(P< 0.05);且治疗组48、72 h心脏指数升高程度明显优于对照组,24、48、72 h血乳酸降低程度明显优于对照组,两组比较差异有统计学意义(P< 0.05)。治疗后,对照组第5、7天GCS评分明显高于第1天,治疗组第3、5、7天GCS评分明显高于第1天,同组治疗前后比较差异有统计学意义(P< 0.05);且治疗组第3、5、7天GCS评分升高程度明显优于对照组,两组比较差异具有统计学意义(P< 0.05)。对照组和治疗组的28 d死亡率分别为46.43%、37.93%,两组比较差异有统计学意义(P< 0.05)。结论 参附注射液可改善心肺复苏的疗效,升高心脏指数,降低血乳酸,改善脑损伤,降低死亡率,具有一定的临床推广应用价值。
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[Abstract]
Objective To investigate the clinical efficacy of Shenfu Injection in improvement of cardiopulmonary resuscitation. Methods Patients (57 cases) with successful resuscitation of cardiac arrest in the First Teaching Hospital of Tianjin University of TCM from January 2015 to June 2016 were randomly divided into control group (28 cases) and treatment group (29 cases). Patients in the control group were given salvage therapy, including mechanical ventilation, cardiac defibrillation and drug (epinephrine, dopamine, amiodarone hydrochloride, and sodium bicarbonate), after the recovery of spontaneous heartbeat, and given actively maintain circulatory and mild hypothermia therapy. Patients in the treatment group were iv administered with Shenfu Injection on the basis of the control group at the early stage of rescue, 100 mL added into 5% glucose solution 250 mL, once daily. Patients in two groups were treated for 1 week. After treatment, the cardiac index and blood lactate, GCS scores, and mortality rate in two groups were compared. Results After treatment, the cardiac indexes at 24, 48, and 72 h in two groups were higher than those at 1 h in the same group, but the blood lactate at 12, 24, 48, and 72 in two groups were lower than those at 1 h in the same group, and the difference was statistically significant in the same group (P < 0.05).The cardiac indexes at 48 and 72 h in the treatment group were higher than that at the same time in the control group, the blood lactates at 24, 48, and 72 in the treatment group were lower than those at the same time in the control group, with significant difference between two groups (P < 0.05). After treatment, the GCS scores at 5th and 7th day in the control group were higher than those at the first day in the same group, the GCS scores on day 3, 5 and 7 in the treatment group were higher than those on day 1 in the same group, and the difference was statistically significant in the same group (P < 0.05). And the GCS scores on day 3, 5 and 7 in the treatment group were higher than those at the same time in the control group,with significant difference between two groups (P < 0.05). After treatment, the 28 d mortality rates in the control and treatment groups were 46.43% and 37.93%, respectively, and there was difference between two groups (P < 0.05). Conclusion Shenfu Injection can improve the curative effect of cardiopulmonary resuscitation, increase cardiac index, decrease blood lactate, improve brain damage, and induce mortality rate, which has a certain clinical application value.
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