生脉注射液对烧伤后“休克心”防治作用的前瞻性临床研究

Clinical research of the effect of Shengmai injection on the management of " shock heart " after burns

目的观察生脉注射液对严重烧伤患者伤后“休克心”的防治作用。方法严格按照临床科研方法设计前瞻性试验方案,将笔者单位符合入选标准的20例严重烧伤患者按完全随机化方法分为给药组和对照组,每组10例。患者入院后均在常规复苏补液的基础上另建1条静脉通道,给药组将生脉注射液40 ml加入50 g／L葡萄糖注射液250 ml中静脉滴注,1次／d,共用3 d;对照组以同样方式静脉滴注未加生脉注射液的50 g／L葡萄糖注射液290 ml。于伤后12 h和1、2、3、4、5 d抽取两组患者股静脉血,检测血清心肌型肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、心肌肌钙蛋白Ⅰ(cTnI)的含量。并于滴注前及滴注后1、2、3、5、7 d同法抽血检测两组患者的肝、肾功能及凝血功能指标。结果伤后12 h给药组、对照组患者血清中CK-MB、LDH、cTnI含量均达峰值,分别为(52±20)U／L、(5．9±1．3)μmol·s-1·L-1、(0．274±0．231)μg／L和(91±31)U／L、(8．5±1．8)μmol·s-1·L-1、(0．584±0．192)μg／L,随治疗时间推移呈逐渐下降趋势。但给药组与对照组比较,各项指标在伤后2 d或3 d内下降更显著(P<0．05)。结论患者严重烧伤后早期应用生脉注射液可有效地防治“休克心”损害,对心肌细胞起到一定的保护作用。

Objective To investigate the effeet of Shengmai injeetion on the management of ＂shoek Methods Twenty patients with severe burns were enrolled in the study and randomly divided into two groups according to the clinical research method, i.e. treatment group （ n = 10, with intravenous infusion of 40 ml Shengmai injection together with 250ml 50 g/L glucose solution for 3 days, 1 time/ per day） and control group（ n = 10, with intravenous infusion of 290 ml 50 g/L glucose injection liquid for 3 days, 1 time/per day）. Beside the venous line used for routine fluid resuscitation for burn shock, another venous line was set up after hospitalization for the administration of the drug. Blood samples were obtained from the femoral vein in both groups at 12 post-bum hour（PBH） , and on 1,2,3,4 and 5 post bum days （PBD） for the determination of serum contents of ereatine kinase-MB （CK-MB）, lactate dehydrogenase （LDH） and cardiac troponin I （eTnI）. The changes in hepatic and renal function, as well as eoagulability were determined before drug infusion and on 1 ,2,3,5 and 7 PSDs. Results The serum content of CKMB, LDH and eTnI reached the peak at 12 PBH in both groups[ （52 ±20）U/L, （5.9 ± 1.3） μmol·s^-1·L^-1, （0.274±0.231）μg/L in treatment group ]and [（91 ±31）U/L, （8.5 ± 1.8）μmol·s^-1·L^-1, （0. 584 ± 0. 192）μg/L in control group ]. All of them decreased with the passage of time, but in the treatment group they decreased more markedly within 2 or 3 PBD compared with those in control group （ P 〈 0. 05）. Conclusion Early administration of Shengmai intravenously is beneficial to the protection of myocardial cells and in the management of the ＂shock heart＂damage.