左卡尼汀在严重烧伤休克心应用的研究

Clinical Research of the Effect of L-carnitine Injection on the Management of "Shock heart"after Burns

目的:观察左卡尼汀注射液对严重烧伤患者"休克心"的疗效。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,治疗组予左卡尼汀3g加入5%葡萄糖溶液250ml中静脉滴注,每日1次。对照组予常规治疗,具体包括:维生素C150mg/kg加入5%葡萄糖250ml中静脉滴注,每日1次,口服维生素E50mg/d,每日1次,口服泛癸利酮(辅酶Q10)10mg,每日3次。两组疗程均为14d。于伤后12h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±20U/L,5.9±1.3μmol.s-1.L-1,(0.274±0.231)μg/L和(91±31)L/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2d或3d内下降更显著(P<0.05)。结论:严重烧伤患者早期应用左卡尼汀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 effect of L - carnitine injection on the management of ＂ shock heart＂ after burns. Method： Twenty patients with severe burns were enrolled in the study and randomly divided into two groups according to the clinical research method, treatment group （ n = 10, with intravenous infusion of 3g L- carnitine injection together with 250ml glucose solution for 14 days, once per day） and control group （ n = 10, with intravenous infusion of vitamin C 3g injection together with 250ml glucose solution for 14 days, once per day, vitamin E 50mg/d once a day and ubide- earenone lOmg three times a day to be taken orally）. Beside the venous line used for routine fluid resuscitation for bum 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 burn days （ PBD ） for the determination of serum contents of creatine kinase - MB （ CK - MB ）, lactate dehydrogenase （ LDH） and cardiac troponin I （ cTnI ）. 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. Result： The serum content of CK - MB, LDH and cTnI reached the peak at 12 PBH in both groups 52 ±20U/L , 5.9± 1.31μmol · s ^- 1 · L ^- 1, 0.274±0.231μg/L_ in treat- ment group and 91 ± 31U/L,8.5 ± 1.81μmol · s^- 1 · L^- 1, 0.584±0. 192μg/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 L - carnitine intravenously is beneficial to the protection of myocardial cells and in the management of the ＂shock heart＂ damage.