早期采用亚低温配合参附注射液治疗心脏骤停后综合征的临床效果

Therapeutic effects of early-stage mild hypothermia combined with Shenfu injection in treating patients with post cardiac-arrest syndrome

目的探讨早期采用亚低温配合参附注射液对心脏骤停后综合征的临床疗效和预后的影响。方法选择心肺复苏(CPR)自主循环恢复后病例68例,采用随机数字表法分为观察组(34例)和对照组(34例),对照组按CPR与心血管急救指南行常规治疗以及亚低温处理,观察组在此基础上加用参附注射液。比较两组病例CPR后2 h内瞳孔、眼球和肌张力变化、呼吸、心率、平均动脉压、血氧饱和度;治疗前及心肺复苏ROSC后第3、7、14天格拉斯哥昏迷评分(GCS)、神经功能缺损评分(NFI)、脑功能分级(CPC)、序贯器官衰竭估计评分(SOFA),以及28 d后的存活率。结果 CPR后观察组的心率(77.71±3.68次/分钟)、呼吸(21.29±1.70次/分钟)、平均动脉压(74.62±5.62 mm Hg)、血氧饱和度(89.23%±6.78%)均高于对照组(分别为每分钟67.85±2.25次、19.24±1.07次、64.48±4.25 mm Hg、79.41%±6.82%),差异有统计学意义(P<0.05);瞳孔变小(55.88%)、眼球活动(58.82%)、肌张力增加(55.88%)的比例均多于对照组(分别为29.41%、32.35%、29.41%),差异有统计学意义(P<0.05)。治疗后3、7和14 d观察组的GCS(分别为9.71±3.83、12.78±3.78、14.71±0.21)均高于对照组(分别为8.36±3.25、9.58±3.24、13.02±1.08),而NFI(分别为32.37±5.32、26.48±5.25、22.65±2.87)和CPC(分别为2.82±1.21、1.94±0.78、1.08±0.36)均分别低于对照组的NFI(分别为39.93±6.28、36.56±5.28、32.61±6.89)和CPC(分别为3.46±0.81、2.73±0.82、1.95±0.54),差异有统计学意义(P<0.05)。治疗后3、7 d观察组的SOFA(分别为2.58±0.83、2.06±0.67)低于对照组(分别为4.27±1.24、3.92±1.16),差异有统计学意义(P<0.05)。治疗28 d后的存活率(38.24%)高于对照组(14.71%)(P<0.05)。结论早期亚低温配合参附注射液治疗PCAS患者,能恢复神经功能,保护脑功能和重要脏器功能,从而改善患者的预后。

Objective To explore therapeutic effects of early-stage mild hypothermia combined with Shenfu injection in treating patients with post cardiac-arrest syndrome.Methods A total of 68 patients with restoration of spontaneous circulation（ROSC）after CPR treated in The Gezhouba Group Central Hospital from September 2012 to August 2015 were chosen and randomized into observation group（n = 34）and control group（n = 34）.Patients in controls were given convenient treatment together with mild hypothermia according to CPR and cardiovascular first-aid guideline,while patients in observation group were given intravenous injected Shenfu injection on the basis of convenient treatment and mild hypothermia.The changes of pupils,ocular movement and muscular tension,respiratory rate,heart rate,MAP,SPO 2 hours after CPR,and GCS,NFI,CPC,SOFA before CPR and 3,7,14 days after ROSC,and survival rate 28 days later between 2 groups were compared.Results The heart rate（77.71 ± 3.68 per min）,respiratory rate（21.29 ± 1.70 per min）,MAP（74.62 ± 5.62 mm Hg）,SPO（89.23% ± 6.78%）in observation group were higher than those in controls（67.85 ± 2.25 per min,19.24 ± 1.07 per min,64.48 ± 4.25 mm Hg,79.41% ± 6.82% respectively）with difference being statistically significant（P〈0.05）.The proportion of pupils becoming smaller（55.88%）,ocular movement（58.82%）,and muscular tension increasing（55.88%）in observation group were higher than those in controls（29.41%,32.35%,29.41% respectively）with difference being statistically significant（P〈0.05）.GCS in observation group 3,7 and 14 days after treatment（9.71 ± 3.83,12.78 ± 3.78,14.71 ± 0.21 respectively）were all higher than those in controls（8.36 ± 3.25,9.58 ± 3.24,13.02 ± 1.08 respectively）,meanwhile,NFI（32.37 ± 5.32,26.48 ± 5.25,22.65 ± 2.87 respectively）and CPC（2.82 ± 1.21,1.94 ± 0.78,1.08 ± 0.36 respectively）in observation group 3,7and 14 days after treatment were all lower than those of controls（NFI： 39.93 ± 6.28,36.56 ± 5.28,32.61 ± 6.89 respectively,CPC：3.46 ± 0.81,2.73 ± 0.82,1.95 ± 0.54 respectively）（P〈0.05）.SOFA in observation group 3 and 7 days after treatment（2.58 ±0.83,2.06 ± 0.67 respectively）were lower than those in controls（4.27 ± 1.24,3.92 ± 1.16 respectively）（P〈0.05）.The survival rate（38.24%）of observation group 28 days after treatment was higher than that of controls（14.71%）（P〈0.05）.Conclusions Early-stage mild hypothermia combined with Shenfu injection in treating patients with PCAS can restore nerve function and protect brain function and important organs function to improve the prognosis of patients.