参附注射液对心肺复苏多脏器功能保护的研究  

The effects of Shenfu injection on the multiple-organ protection in patients after cardiopulmonary resuscitation

作　　者：黄君龄[1] 孟婧[1] 袁颖[2] 薛明明[1] 杨伟强[3] 顾国嵘[1] 姚晨玲[1] 童朝阳[1] 沈洪[1] 宋振举[1] 陶振钢[1] 

机构地区：[1] 复旦大学附属中山医院急诊科, 上海200032 [2] 复旦大学附属中山医院老年科, 上海200032 [3] 上海交通大学附属仁济医院急诊科

出　　处：《中华急诊医学杂志》2014年第7期791-795,共5页Chinese Journal of Emergency Medicine

摘　　要：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.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.

关 键 词：参附注射液 心肺复苏 多器官功能不全 

分 类 号：R459.7[医药卫生—急诊医学]