参附注射液对急性呼吸窘迫综合征机械通气患者心血管功能保护作用的研究

Study on protection of Shenfu injection(参附注射液) on cardiovascular function in acute respiratory distress syndrome patients treated with mechanical ventilation

目的:探讨参附注射液对急性肺损伤/急性呼吸窘迫综合征(AL I/ARDS)机械通气(M V)患者心血管功能的保护作用机制。方法:选择29例AL I/ARDS实施M V患者,随机分为参附注射液组(15例,SF组)和生理盐水对照组(14例,C组)。SF组于M V前15 m in开始静脉滴注参附注射液100 m l加生理盐水400 m l;C组静脉滴注等量生理盐水,滴速均为5 m l.kg-1.h-1。两组均于M V前及M V 5、15、30和60 m in监测平均动脉压(M AP)、心率(HR)及中心静脉压(CVP)等血流动力学指标,并分别进行组内及组间比较。结果:SF组在M V 60 m in内与M V前的血流动力学指标比较无明显改变(P均>0.05),表明患者的血流动力学稳定。而C组M V 60 m in内的血流动力学指标与M V前比较差异有显著性(P均<0.05),表明参附注射液对这类患者心血管功能有很好的保护作用。结论:M V主要并发症之一是心排血量减少、血压下降,在AL I/ARDS实施M V患者尤为常见。在M V时尤其是初期对此类患者常规应用参附注射液将会起到很好的心血管保护作用。

Objective： To investigate the mechanism of protection of Shenfu injection （SFI,参附注射液） on cardiovascular function in patients suffering from acute lung injury/acute respiratory distress syndrome （ALI/ARDS） treated with mechanical ventilation （MV）. Methods： Twenty -nine ALI/ARDS patients treated with MV were randomly divided into SFI group （n= 15） and control group （n= 14）. SFI 100 ml-bnormal saline 400 ml was dripped intravenously in SFI group patients with a speed of 5 ml ·kg^-1·h^-1 15 minutes before MV, while equal amount of normal saline was given in the patients of control group. The hemodynamic indexes such as mean arterial pressure （MAP）, heart rate （HR） and central venous pressure （CVP） of both groups before MV and 5, 15, 30, 60 minutes after MV were recorded and compared between the two groups as well as compared to those before MV in the same group. Results： There was no obvious change of hemodynamics in SFI group within 60 minutes compared to those before MV （all P〉0.05）, indicating that the hemodynamics was steady. The difference was significant on hemodyonamics in the control group between 60 minutes of MV compared to those before MV （all P〈0. 05）. It showed that SFI had better protection on cardiovascular function in this kind of patients. Conclusion： One of the major complications of MV is the reduction of cardiac output and drop of blood pressure, and it is frequently seen in ALI/ARDS patients. Using SFI routinely in ALI/ARDS patients treated with MV, especially in early period, would have better protection to their cardiovascular function.