摘要
目的观察以人参附子为主药的中药针剂或汤剂对心搏骤停后综合征(PCAS)患者的临床疗效。方法采用回顾性研究方法。选择浙江省立同德医院2017年1月至2022年11月急诊重症监护病房(EICU)收治的50例PCAS患者作为研究对象。根据是否加用中药治疗将患者分为中西医结合治疗组(21例)和单纯西医治疗组(29例)。两组患者均依据《2015年美国心脏学会心肺复苏与心血管急救指南》给予西医呼吸支持、稳定循环、亚低温脑保护、纠正水和电解质及酸碱平衡、去除病因、抗感染等治疗;中西医结合治疗组在单纯西医治疗组基础上加用以人参、附子为主药的中药针剂或汤剂,7 d为1个疗程,连续治疗2个疗程。比较两组患者72 h存活率、出院存活率、神经功能良好出院率,以及治疗前和治疗后动脉血气分析指标pH值、二氧化碳分压(PaCO_(2))、血乳酸(Lac)、D-二聚体、肌钙蛋白、心肌酶谱水平的差异。结果与单纯西医治疗组比较,中西医结合治疗组72 h存活率、出院存活率、神经功能良好出院率均明显升高〔72 h存活率:100.00%(21/21)比55.17%(16/29),出院存活率:61.90%(13/21)比17.24%(5/29),神经功能良好出院率:42.86%(9/21)比10.34%(3/29),均P<0.05〕。两组治疗后pH值水平均较治疗前明显升高,PaCO_(2)、Lac水平均较治疗前明显降低(均P<0.05);治疗后中西医结合治疗组Lac水平明显低于单纯西医治疗组〔mmol/L:1.30(1.00,1.70)比1.70(1.20,4.80),P<0.05〕。中西医结合治疗组治疗后D-二聚体、肌钙蛋白、心肌酶谱水平均较治疗前明显降低(均P<0.05),而单纯西医治疗组治疗前后D-二聚体、肌钙蛋白、心肌酶谱水平比较差异均无统计学意义(均P>0.05),故治疗后中西医结合治疗组D-二聚体、肌钙蛋白、心肌酶谱水平均明显低于单纯西医治疗组〔D-二聚体(mg/L):2.56(1.67,6.73)比4.30(3.22,17.37),肌钙蛋白(μg/L):0.22(0.08,0.99)比0.46(0.15,1.44),肌酸激酶(CK,U/L):237.50(116.00,643.83)比380.50(145.25,1576.25),肌酸激酶同工酶(CK-MB,U/L):3.77(1.97,8.75)比29.50(12.38,84.54),均P<0.05〕。结论采用人参附子为主药的中药针剂或汤剂辅助治疗PCAS患者疗效好,有利于提高PCAS患者的72 h存活率、出院存活率、神经功能良好存活率。
Objective To observe the clinical effect of Chinese herbal medicine injection or decoction with Ginseng and Aconite as the main drugs on patients with post-cardiac arrest syndrome(PCAS).Methods A retrospective study was conducted.Fifty PCAS patients admitted to the emergency intensive care unit(EICU)of Tongde Hospital of Zhejiang Province from January 2017 to November 2022 were selected as the study subjects.Patients were divided into a combination of traditional Chinese and western medicine treatment group(21 cases)and a simple western medicine treatment group(29 cases)based on whether to add traditional Chinese medicine treatment.In accordance with the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,both groups were given western medical treatment such as respiratory support,stabilization circulation,mild hypothermia brain protection,correction of water-electrolyte acid-base balance,removal of etiology,and anti-infection.The combination of traditional Chinese and western medicine treatment group was supplemented with traditional Chinese medicine injection or decoction mainly composed of Ginseng and Aconite on the basis of the simple western medicine treatment group.One course of treatment was performed every 7 days,and two consecutive courses of intervention were performed.The 72-hour survival rate,discharge survival rate,good neurological function discharge rate,and the differences of arterial blood gas analysis index pH value,partial pressure of carbon dioxide(PaCO_(2)),blood lactic acid(Lac),D-dimer,troponin and myocardial enzyme profile before and after treatment were compared between the two groups.Results Compared with the simple western medicine treatment group,the combination of traditional Chinese and western medicine treatment group showed a significant increase in 72-hour survival rate,discharge survival rate,and good neurological function discharge rate[72-hour survival rate:100.00%(21/21)vs.55.17%(16/29),discharge survival rate:61.90%(13/21)vs.17.24%(5/29),and good neurological function discharge rate:42.86%(9/21)vs.10.34%(3/29),all P<0.05].After treatment,the pH level in arterial blood gas analysis of both groups was significantly higher than before treatment,and the PaCO_(2) and Lac levels were significantly lower than before treatment(all P<0.05).After treatment,the Lac level in the combination of traditional Chinese and western medicine treatment group was significantly lower than that in the simple western medicine treatment group[mmol/L:1.30(1.00,1.70)vs.1.70(1.20,4.80),P<0.05].After treatment,the levels of D-dimer,troponin and myocardial enzyme spectrum in the combination of traditional Chinese and western medicine treatment group were significantly lower than those before treatment(all P<0.05),while there was no significant difference in the levels of D-dimer,troponin and myocardial enzyme spectrum in the simple western medicine treatment group before and after treatment(all P>0.05).Therefore,after treatment,the levels of D-dimer,troponin and myocardial enzyme in the combined treatment group were significantly lower than those in the simple western treatment group[D-dimer(mg/L):2.56(1.67,6.73)vs.4.30(3.22,17.37),troponin(μg/L):0.22(0.08,0.99)vs.0.46(0.15,1.44),creatine kinase(CK,U/L):237.50(116.00,643.83)vs.380.50(145.25,1576.25),MB isoenzyme of CK(CK-MB,U/L):3.77(1.97,8.75)vs.29.50(12.38,84.54),all P<0.05].Conclusion The traditional Chinese medicine injection or decoction with ginseng and aconite as the main drugs has a good effect on PCAS patients,which is conducive to improving the 72-hour survival rate,discharge survival rate and survival rate of patients with good neurological function.
作者
王宇璐
李海林
朱高尚
张亮
杨峥
余丹凤
Wang Yulu;Li Hailin;Zhu Gaoshang;Zhang Liang;Yang Zheng;Yu Danfeng(Department of Emergency,Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2023年第3期325-328,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省医药卫生科技计划项目(2020KY087)。
关键词
心肺复苏
心搏骤停
心搏骤停后综合征
人参
附子
参附注射液
Cardiopulmonary resuscitation
Sudden cardiac arrest
Post-cardiac arrest syndrome
Ginseng
Aconite
Shenfu injection
