红花黄色素治疗急性肺栓塞溶栓后缺血再灌注损伤的临床研究

Observation of safflor yellow on ischemical reperfusion injury with acute lung embolism after thrombolysis

目的观察红花黄色素联合低分子肝素钙治疗肺栓塞溶栓后缺血再灌注损伤的临床疗效。方法将60例无溶栓禁忌证的急性大面积肺栓塞患者随机分为2组。对照组30例于诊断大面积肺栓塞后6～12h内给予尿激酶20000U／kg静脉溶栓，溶栓12h后给予脐周皮下注射低分子肝素钙5000U，每12h1次．连用7d。治疗组30例在对照组治疗基础上于溶栓后2h给予红花黄色素150mg／d静脉滴注，连用15d。观察2组溶栓前、溶栓后lO、20d氧合指数、肺动脉压变化及28d的死亡率；测定血清超氧化物歧化酶（SOD）活性及丙二醛（MDA）水平。结果治疗组溶栓后氧合指数较对照组明显升高，肺动脉压明显下降；治疗组溶栓后血清SOD活性较对照组明显升高，而血清MDA水平较对照组明显下降，差异均有统计学意义（P〈0．05）；治疗组28d死亡率明显低于对照组。结论红花黄色素可以明显改善急性大面积肺栓塞患者溶栓后机体的氧化应激水平，减轻肺动脉高压，改善预后。

Objective To explore the effect of combination of safflor yellow and the low molecular heparin calcium on pulmonary ischemia - reperfusion injury after thrombolysis. Methods 60 cases of acute massive pulmonary embolisms who had not thrombolytic contraindications were randomly divided into the treatment group （ n = 30） and control group （ n = 30）. Within 6 - 12 h after confirmed massive pulmonary embolism patients in control group were given intravenous thmmbolysis treatment with urokinase （20 000 U/kg）, after thrombolysis 12 hours low molecular heparin calcium （per 5 000 U,1/12 h） were injected. The course was 7days. Patients in treatment group were treated by combination of safflor yellow intravenous infusion of 150 mg/d and routine therapy, the course was 15 days. p （ 02 ）/FIO2 and PAP were measured before thrombolysis, 10 days and 20 days after thrombolysis. 28 - day mortality rate was observed. The levels of SOD and MDA in serum with were detected by hydroxylamine oxidation and with tba - calorimetric method. Results p （ O2 ）/FIO2 in treatment group after thrombolysis were significantly increased in comparison with that in the control group （ P 〈 0.05 ） ; PAP were significantly decreased （ P 〈 0.05 ）. The serum level of SOD in treatment group were significantly increased in comparison with that in the control group （P 〈 0.05 ） . The serum level of MDA were significantly decreased （ P 〈 0.05 ）. 28 - day mortality rate I treatment group was lower than that in the control group （ P 〈 0.05）. Conclusion Safflor yellow may improve the level of oxidative stress after thrombolysis in acute massive pulmonary embolism patients, reduce PAP, improve prognosis.