摘要
目的探讨肾上腺素联合小剂量乌司他丁在心肺复苏中的临床应用价值及作用机制。方法将2010年1月至2012年12月杭州市余杭区第二人民医院收治的82例心跳呼吸骤停患者完全随机分为观察组(45例)和对照组(37例)。对照组行标准心肺复苏时静脉注射肾上腺素(1.0mg)+纳洛酮(2.0mg),观察组在对照组基础上早期静脉注射小剂量乌司他丁(10万IU),治疗至自主循环恢复(ROSC)、自主呼吸恢复或停止抢救,观察2组复苏效果、心肺复苏成功率、格拉斯哥昏迷量表(GCS)评分、24h生存率及出院生存率,同时观察2组ROSC后实验室检测指标、复苏后多脏器功能障碍综合征(PR—MODS)发生率及受累器官、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分及28d生存率。结果观察组ROSC率和自主呼吸恢复率分别为77.8%(35/45)、57.8%(26/45),对照组分别为54.1%(20/37)、29.7%(11/37),差异均有统计学意义(均P〈0.05)。观察组ROSC和自主呼吸恢复时间分别为(7.3±1.6)、(27.4±1.7)min,对照组分别为(10.2±1.3)、(49.3±1.6)min,差异均有统计学意义(均P〈0.05)。观察组GCS评分(ROSC即刻)、心率(ROSC后5、10min)、24h生存率及出院生存率均明显优于对照组[GCS评分:(7.9±1.3)分比(5.5±1.6)分,心率:(108±14)次/min比(144±11)次/min,(102±14)次/min比(128±13)次/min,24h生存率:71.1%(32/45)比45.9%(17/37),出院生存率:62.2%(28/37)比37.8%(14/45)],差异均有统计学意义(均P〈0.05)。观察组血清白蛋白、乳酸、肿瘤坏死因子0l及白细胞介素6水平均低于对照组,差异均有统计学意义(均P〈0.05)。观察组PR—MODS发生率和28d生存率分别为17.8%(5/28)、71.4%(20/28),对照组分别为42.9%(6/14)、50.0%(7/14),差异有统计学意义(均P〈0.05)。观察组PR—MODS受累器官数和APACHEⅡ评分也优于对照组(均P〈0.05)。结论肾上腺素联合小剂量乌司他丁能明显提高心肺复苏成功率,降低血清炎性因子水平和PR—MODS发生率。
Objective To explore the clinical efficacy and mechanism of epinephrine combined with ulinastatin in cardiopulmonary resuscitation. Methods According to a stratified randomization method, 82 cardiopulmonary arrest patients were divided into the observation group (n = 45 ) and the control group (n = 37 ). The control group was treated with intravenous injection of epinephrine (1.0 mg) + naloxone (2.0 mg) during the early stage cardiopulmonary resuscitation. The observation group was treated with intravenous injection of low dose of ulinastatin (100 000 IU) on the basis of the control group. Resuscitation effect, survival rate ,laboratory indicators and the incidence of MODS for both groups were observed. Results The restoration of spontaneous circulation of the observation group and the control group were 77.8% (35/45) and 54. 1% (20/37), respectively; the restoration of spontaneous breathing of the observation group and the control group were 57.8% (26/45)and 29.7% (11/37 ), respectively; there was significant difference between the two groups ( P 〈 0.05 ). The observation group was significantly better than the control group in terns of GCS score, heart rate ,24 h survival rate and discharge survival rate [ GCS scores: (7.9 ±1.3 ) scores vs (5.5 ±1.6) scores, heart rate: ( 108 ±14) times per min vs ( 144 ±11 ) times per rain, ( 102 ±14) times per min vs (128 ±13 )times per min,24 h survival rate: 71.1% (32/45) vs 45.9% (17/37) , discharge survival rate: 62. 2% ( 28/37 ) vs 37. 8% ( 14/45 ) ] , there was significant difference between two groups (P 〈 0.05 ). The observation group was significantly lower than the control group regarding the levels of albumin, lactic acid, tumor necrosis factor-α and interlenkin-6 ; there was significant difference between the two groups ( P 〈 0.05). The incidence of MODS of the observation group and the control group was 17.8% (5/28) and 42.9% (6/14) , respectively ; 28 d survival rate of the observation group and the control group was 71.4% (20/28) and 50.0% (7/14), respectively; there was significant difference between the two groups (P 〈0.05). The observation group was significantly better than the control group regarding the involving organs of MODS and APACHE score (P 〈 0.05 ). Conclusions Epinephrine combined with low-dose ulinastatin can significantly improve the success rate of CPR, reduce the incidence of MODS and the levels of inflammatory eytokine.
出处
《中国医药》
2015年第3期328-332,共5页
China Medicine
关键词
心肺复苏术
肾上腺素
乌司他丁
Cardiopulmonary resuscitation
Epinephrine
Ulinastatin