生脉注射液对猝死复苏中心肌保护作用的临床研究

Protective effect of Shengmai injection on myocardium during the cardiopulmonary resuscitation

目的探讨生脉注射液对心脏骤停患者复苏过程中的心肌保护作用,并初步探讨其作用机制。方法将42例患者随机分为两组,治疗组(生脉组)23例,对照组19例。将两组病例均给予心肺复苏基本生命支持,并同时给予复苏常用药物治疗,治疗组在复苏即刻给予生脉注射液50 mL静推,观察两组病例复苏前、复苏即刻、再灌注后10min、再灌注后30min、再灌注后6h心肌酶学(CK、CK-MB、LDH、HBDH、GOT)及SOD、NO、MDA的情况,并运用菲利普OC-24床旁心电监护仪动态监测复苏后并发症(心律失常、心力衰竭、休克)、死亡等的发生率。结果对照组复苏后各时期血清MDA升高,SOD活性下降,与复苏前比较差异均有统计学意义(P＜0．01)。生脉组复苏后各时期血清MDA上升、SOD下降的幅度明显小于同期对照组(P＜0．05)。对照组复苏后NO下降,而生脉组较同期对照组升高(P＜0．01);两组患者心脏恢复灌注后心肌酶学均呈上升趋势,但生脉组的升高显著低于同期对照组(P＜0．05);两组患者复苏后均有心律失常发生,生脉组的发生率远低于对照组。结论生脉注射液能升高血清中NO水平,增加SOD活性和减少MDA水平,使LDH、CK、CK-MB生成减少,抑制了对心肌细胞的坏死性损伤,保护缺血再灌注细胞,提高了复苏的成功率。

Objective To explore the protective effect and its mechanism of Shengmai injection on myocardium during cardiopulmonary resuscitation. Methods A clinical study was performed in 42 patients including 23 patients with Shengmai injection treatment and 19 cases with routine treatment. Blood samples were collected during the different courses of resuscitation to investigate the level of myocardial enzymes and SOD, NO, MDA at the same time, the incidences of the complications were also monitored. Results Compared with the routine treatment group, expression of SOD and NO was markedly increased while expression of MDA and myocardial enzymes were significantly decreased in the Shengmal treatment group during the different courses of cardiopulmonary resuscitation （ P 〈 0. 05 or P 〈 0. 01 ） . The incidence of complications in the Shengmai treatment group was less than that of the routine treatment group. Conclusion Shengmai injection can protect myocardium from the ischemia - reperfusion injury and improve successful rate by raising NO level and SOD activity, decreasing MDA level.