参附注射液对急性心肌梗死并发低血压状态患者多糖包被的影响

Effect of Shenfu Injection on polysaccharide inclusion in patients with acute myocardial infarction complicated by hypotension

目的探讨参附注射液对急性心肌梗死(AMI)并发低血压状态患者多糖包被(EG)的影响。方法选择2021年6月—2022年12月哈励逊国际和平医院收治的AMI并发低血压患者180例,用简单随机数字表法分为对照组和试验组,每组各90例。对照组给予常规液体复苏、抗血小板聚集、抗凝、调脂治疗,同时给予多巴胺注射液持续泵入,将血压控制在90 mmHg/60 mmHg(1 mmHg=133 Pa);试验组在对照组基础上加用参附注射液100 mL+0.9%氯化钠注射液500 mL静脉滴注,治疗3 d。分别于治疗前、治疗3 d后,检测血常规、高密度脂蛋白胆固醇(HDL-C)、N末端B型脑钠尿肽(NT-proBNP)、可溶性肿瘤因子2抑制剂(sST2)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、内皮素-1(ET-1)、一氧化氮(NO)、多配体蛋白聚糖-1(SDC-1)、透明质酸(HA)、硫酸类肝素(HS)、血栓调节蛋白(TM)水平。观察并记录入院后24、48、72 h平均收缩压、尿量、心功能情况,评估低血压状态治疗效果。观察患者30d内恶性心血管事件的发生情况。结果试验组总有效率(93.33%)显著高于对照组(81.10%),差异有统计学意义(P<0.05)。试验组在入院后24 h平均收缩压、尿量已经显著高于对照组(P<0.05);试验组使用多巴胺时间比对照组缩短,使用多巴胺的总量低于对照组,改善预后药物使用时间短于对照组(P<0.05)。治疗前,两组患者中性粒细胞与淋巴细胞比值(NLR)、单核细胞与HDL-C比值(MHR)、CRP、IL-6、TNF-α、SDC-1、HA、HS、TM、ET-1、NO、NTproBNP、sST2、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)比较,差异无统计学意义(P>0.05)。治疗后,两组患者NLR、MHR、CRP、IL-6、TNF-α、SDC-1、HA、HS、TM、ET-1、NT-proBNP、sST2、LVEDD均低于本组治疗前,NO、LVEF高于本组治疗前,差异有统计学意义(P<0.05);试验组NLR、MHR、CRP、IL-6、TNF-α、SDC-1、HA、HS、TM、ET-1、NT-proBNP、sST2、LVEDD低于对照组,NO、LVEF高于对照组,差异有统计学意义(P<0.05、0.01)。AMI并发低血压患者,SDC-1与NLR、MHR、CRP、IL-6、TNF-α、NT-proBNP呈正相关;与LVEF呈负相关。ROC结果示,SDC-1对AMI并发低血压患者30 d内死亡风险有一定的预测价值,曲线下面积为0.824。结论参附注射液能够减轻AMI并发低血压状态患者EG的脱落,保护血管内皮细胞,升高患者血压。

Objective To investigate the effect of Shenfu Injection on polysaccharide encapsulation(EG)in patients with acute myocardial infarction(AMI)complicated by hypotension.Method A total of 180 patients with AMI complicated with hypotension admitted to Harrison International Peace Hospital from June 2021 to December 2022 were selected and divided into a control group and an experimental group using a simple random number table method,with 90 patients in each group.The control group was treated with routine liquid resuscitation,antiplatelet aggregation,anticoagulation,and lipid-lowering therapy,while dopamine injection was continuously pumped in to control blood pressure at 90/60 mmHg(1 mmHg=133 Pa).The experimental group received intravenous infusion of 100 mL of Shenfu Injection and 500 mL of 0.9%Sodium Chloride Injection on the basis of the control group for three days.Blood routine,high-density lipoprotein cholesterol(HDL-C),N-terminal B-type brain natriuretic peptide(NT-proBNP),soluble tumor factor 2 inhibitor(sST2),C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)were detected before and three days after treatment,respectively.Levels of endothelin-1(ET-1),nitric oxide(NO),multi ligand proteoglycan-1(SDC-1),hyaluronic acid(HA),heparin sulfate(HS),and thrombomodulin(TM)were detected before and three days after treatment,respectively.Observe and record the average systolic blood pressure,urine volume,and cardiac function at 24,48,and 72 hours after admission,and evaluated the treatment effect of hypotension.Observe the occurrence of malignant cardiovascular events in patients within 30 days.Results The total effective rate of the experimental group(93.33%)was significantly higher than that of the control group(81.10%),with a statistically significant difference(P<0.05).The average systolic blood pressure and urine output in the experimental group were significantly higher than those in the control group 24 hours after admission(P<0.05).The duration of dopamine use in the experimental group was shorter than that in the control group,and the total amount of dopamine used was lower than that in the control group.The use of drugs to improve prognosis was earlier than that in the control group(P<0.05).Before treatment,there was no statistically significant difference in two groups of NLR,MHR,CRP,IL-6,TNF-α,SDC-1,HA,HS,TM,ET-1,NO,NT-proBNP,sST2,LVEDD,and LVEF(P>0.05).After treatment,patients'NLR,MHR,CRP,IL-6,TNF-α,SDC-1,HA,HS,TM,ET-1,NT-proBNP,sST2,LVEDD were lower than before treatment in this group,while NO and LVEF were higher than before treatment in this group,with statistically significant differences(P<0.05).Experimental groups,NLR,MHR,CRP,IL-6,TNF-α,SDC-1,HA,HS,TM,ET-1,NT-proBNP,sST2,LVEDD were lower than the control group,while NO and LVEF were higher than the control group,with statistically significant differences(P<0.05,0.01).SDC-1 and NLR,MHR,CRP,IL-6,TNF-α,NT-proBNP in patients with AMI complicated by hypotension,shows a positive correlation.There was a negative correlation with LVEF.The ROC results showed that SDC-1 has certain predictive value for the risk of death within 30 days in patients with AMI complicated by hypotension,with an area under the curve of 0.824.Conclusion Shenfu Injection can alleviate the shedding of EG in patients with AMI complicated by hypotension,protect vascular endothelial cells,and increase blood pressure in patients.