参附注射液治疗心脏骤停后综合征效果观察及其对C反应蛋白、平均动脉压的影响

Effect of Shenfu injection on cardiac arteries syndrome and its influence on C - reactive protein and mean arterial pressure

目的 观察参附注射液治疗心脏骤停后综合征（PCAS）的临床效果及其对患者C反应蛋白（CRP）、早期平均动脉压的影响.方法 选择解放军第九八医院2013年9月至2016年9月收治的PCAS患者80例为研究对象,采用随机数字表法将患者分为研究组40例和对照组40例,两组患者均行常规治疗,研究组在常规治疗基础上给予参附注射液静脉滴注,对照组在常规治疗基础上给予等量0.9％ 氯化钠注射液静脉滴注.观察两组患者复苏后4 h、12 h、1 d、2 d、3 d外周血CRP、平均动脉压、格拉斯哥昏迷评分（GCS评分）的变化及90 d生存率.结果 研究组复苏后4 h、12 h、1 d、2 d、3 d外周血CRP分别为（22.01±2.16）mg/L、（34.68±4.95）mg/L、（62.51±3.68）mg/L、（98.65±6.57）mg/L、（100.67±10.03）mg/L,对照组分别为（25.16±3.54）mg/L、（41.52±5.31）mg/L、（75.09±4.58）mg/L、（120.48±10.61）mg/L、（128.26±9.64）mg/L,两组差异均有统计学意义（t=4.804、5.959、13.542、11.063、12.543,均P〈0.01）;研究组复苏后4 h、12 h、1 d、2 d、3 d平均动脉压分别为（78.03±8.65）mmHg、（88.34±10.20）mmHg、（97.05±9.57）mmHg、（105.29±10.45）mmHg、（112.14±9.46）mmHg,均高于对照组的（68.21±8.03）mmHg、（74.01±10.59）mmHg、（83.09±11.25）mmHg、（98.25±9.17）mmHg、（104.68±3.14）mmHg（t=5.262、6.164、5.978、3.203、4.733,均P〈0.01）;研究组复苏后4 h、12 h、1 d、2 d、3 d的GCS评分分别为（5.21±1.12）分、（5.78±2.05）分、（6.85±1.68）分、（7.91±2.57）分、（9.98±2.07）分,均高于对照组的（4.01±2.14）分、（4.22±3.75）分、（4.39±3.89）分、（4.41±2.86）分、（5.06±4.14）分（t=3.142、2.309、3.672、5.757、6.723,均P〈0.05）;研究组复苏后90 d生存率为50％（20/40）,高于对照组的23％（9/40）,两组差异有统计学意义（χ2=6.545,P=0.011）.结论 参附注射液对PCAS患者脏器功能有一定保护作用,可降低CRP,促进血流动力学的恢复,提高生存率.

Objective To investigate the clinical effect of Shenfu injection in the treatment of patients with post - cardiac arrest syndrome（PCAS）,to analyze the patients＇ blood C - reactive protein （CRP） and early mean arterial pressure. Methods From September 2013 to September 2016,80 patients with PCAS in the No. 98 Hospital of PLA were randomly divided into study group and control group according to the digital table,with 40 cases in each group. The study group was treated by Shenfu injection,the control group was treated by saline. The changes of CRP,mean arterial pressure and GCS score at 4h,12h,1d,2d and 3d after resuscitation and the 90d survival rate were observed. Results At 4h,12h,1d,2d and 3d after resuscitation,the peripheral blood CRP levels in the study group were （22. 01 ±2. 16）mg/ L,（34. 68 ± 4. 95）mg/ L,（62. 51 ± 3. 68）mg/ L,（98. 65 ± 6. 57）mg/ L,（100. 67 ± 10. 03）mg/ L, respectively,which in the control group were （25. 16 ± 3. 54）mg/ L,（41. 52 ± 5. 31）mg/ L,（75. 09 ± 4. 58）mg/ L, （120. 48 ± 10. 61）mg/ L,（128. 26 ± 9. 64）mg/ L,respectively,there were statistically significant differences between the two groups（t = 4. 804,5. 959,13. 542,11. 063,12. 543,all P 〈 0. 01）. At 4h,12h,1d,2d and 3d after resuscita-tion,the mean arterial pressure in the study group were （78. 03 ± 8. 65）mmHg,（88. 34 ± 10. 20）mmHg,（97. 05 ± 9. 57）mmHg,（105. 29 ± 10. 45）mmHg,（112. 14 ± 9. 46） mmHg,respectively,which were higher than those in the control group [（68. 21 ± 8. 03）mmHg,（74. 01 ± 10. 59） mmHg,（83. 09 ± 11. 25） mmHg,（98. 25 ± 9. 17） mmHg, （104. 68 ± 3. 14）mmHg]（t = 5. 262,6. 164,5. 978,3. 203,4. 733,all P 〈 0. 01）. At 4h,12h,1d,2d and 3d after resuscitation,the GCS scores of the study group were （5. 21 ± 1. 12） points, （5. 78 ± 2. 05） points, （6. 85 ± 1. 68）points,（7. 91 ± 2. 57）points,（9. 98 ± 2. 07） points,respectively,which were higher than those of the control group [（4. 01 ± 2. 14） points, （4. 22 ± 3. 75） points, （4. 39 ± 3. 89） points, （4. 41 ± 2. 86） points, （5. 06 ± 4. 14）points]（t = 3. 142,2. 309,3. 672,5. 757,6. 723,all P 〈 0. 05）. The survival rate of the study group was 50％（20 / 40） at 90d after resuscitation,which was higher than that of the control group [23％ （9 / 40）]（χ2 = 6. 545,P =0. 011）. Conclusion Shenfu injection has protective effect on the function of patients with CRP after surgery,and can improve the prognosis of patients,it is worthy of clinical use.