安宫牛黄丸在心脏骤停患者心肺复苏术后的应用效果分析

吕昕; 张瑛; 唐文学

doi:10.16766/j.cnki.issn.1674-4152.001951

安宫牛黄丸在心脏骤停患者心肺复苏术后的应用效果分析

doi: 10.16766/j.cnki.issn.1674-4152.001951

杭州师范大学附属医院重症医学科，浙江杭州 310015

基金项目:

浙江省中医药科技计划项目 2016ZB103

浙江省中管局项目 2018ZB101

详细信息

通讯作者:
唐文学, E-mail: maodoubaobei@126.com

中图分类号: R541.78 R28
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出版历程
- 收稿日期: 2020-05-28
- 网络出版日期: 2022-02-16

Application effect of Angong Niuhuang Pills in patients with cardiac arrest after cardiopulmonary resuscitation

Intensive Care Unit, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的观察安宫牛黄丸在急诊心脏骤停(cardiac arrest，CA)患者心肺复苏术(cardiopulmonary resuscitation，CPR)后的应用价值，以期为CA的临床救治提供试验依据。方法将2017年8月—2019年6月杭州师范大学附属医院收治的心脏骤停后恢复自主循环(cardiac arrest and return of spontaneous circulation，CA-ROSC)的90例患者按随机数字表法均分观察组(45例)与对照组(45例)，对照组ROSC后立刻静脉滴注纳洛酮，观察组则在对照组基础上给予安宫牛黄丸，疗程为1周。比较2组脑氧代谢率(cerebral metabolic rate for oxygen，CMRO₂)、氧化应激损伤、血清S100β、基质金属蛋白酶-9(matrix metalloproteinase-9，MMP-9)水平及预后。结果观察组治疗后3 d、7 d时的CMRO₂均显著高于对照组(均P < 0.05)；治疗后观察组超氧化物歧化酶[(96.45±9.47)U/mL]、谷胱甘肽过氧化物酶[(82.58±11.49)U/L]显著高于对照组[(84.25±8.87)U/mL、(73.60±10.75)U/L]，丙二醛[(9.52±1.88)nmol/mL]显著低于对照组[(11.03±3.06)nmol/mL, 均P < 0.05]；治疗后观察组S100β、MMP-9显著低于对照组；观察组脑复苏成功率显著高于对照组，脑复苏成功时间较对照组短，且治疗后观察组格拉斯哥昏迷量表评分显著高于对照组，格拉斯哥-匹兹堡脑功能表现计评分显著低于对照组(均P < 0.05)。结论安宫牛黄丸用于CA患者CPR后可有效改善脑氧代谢，减轻氧化应激损伤及脑损伤，对于预后有益，值得临床推介。
- 安宫牛黄丸 /
- 急诊心脏骤停 /
- 脑氧代谢率 /
- 氧化应激损伤 /
- 血清S100β /
- 基质金属蛋白酶-9
Abstract: Objective To observe the application value of Angong Niuhuang Pills in patients with emergency cardiac arrest (CA) after cardiopulmonary resuscitation (CPR). Methods Total 90 patients with CA and return of spontaneous circulation (CA-ROSC) who were admitted to the General Intensive Care Unit (GICU) of Affiliated Hospital of Hangzhou Normal University from August 2017 to June 2019 were equally divided into observation groups (n=45) and the control group (n=45) by random number table method. The control group was treated with intravenous drip of naloxone immediately after ROSC, while the observation group was treated with Angong Niuhuang Pills based on the treatment of control group. Both groups were treated for 1 week. The cerebral metabolic rate for oxygen (CMRO₂), oxidative stress injury, serum S100β and matrix metalloproteinase-9 (MMP-9) levels and prognosis were compared between the 2 groups. Results At 3 d and 7 d after treatment, CMRO₂ of the observation group was significantly higher than that of the control group (P < 0.05). After treatment, superoxide dismutase [(96.45±9.47) U/mL] and glutathione peroxidase [(82.58±11.49) U/L] of observation group were significantly higher, while malondialdehyde [(9.52±1.88) nmol/mL] was significantly lower, compared with those of the control group [(84.25±8.87) U/mL, (73.60±10.75) U/L, (11.03±3.06) nmol/mL, all P < 0.05]. After treatment, S100β and MMP-9 were significantly lower in the observation group than those in the control group. The proportion of successful cerebral resuscitation in the observation group was significantly higher than that in the control group, and successful cerebral resuscitation time was significantly shorter than the control group. After treatment, the Glasgow Coma Scale (GCS) scores of observation group were significantly higher but the Glasgow-Pittsburgh cerebral performance categories (CPC) scores were significantly lower, compared with the control group (all P < 0.05). Conclusion Angong Niuhuang Pills can effectively improve cerebral oxygen metabolism and reduce oxidative stress injury and brain injury in patients with CA after CPR, which is conductive to the prognosis.
- Angong Niuhuang Pills /
- Emergency cardiac arrest /
- Cerebral metabolic rate for oxygen /
- Oxidative stress injury /
- Serum S100β /
- Matrix metalloproteinase-9

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表 1 2组CA-ROSC患者各时间点外周血CMRO₂比较(x ±s)

组别	例数	治疗前	治疗后3 d	治疗后7 d	F值	P值
观察组	45	141.27±45.66	217.45±56.42^a	239.27±110.49^ab	20.450	< 0.001
对照组	45	145.24±50.38	159.87±66.12^a	185.27±75.34^ab	4.401	0.014
t值		0.391	4.443	2.708
P值		0.696	< 0.001	0.008
注：与同组治疗前比较，^aP < 0.05；与同组治疗后3 d比较，^bP < 0.05。

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表 2 2组CA-ROSC患者治疗前后氧化应激指标比较(x ±s)

组别	例数	SOD(U/mL)		GSH-Px(U/L)		MDA(nmol/mL)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	45	68.48±6.67	96.45±9.47^a	65.84±9.75	82.58±11.49^a	14.34±2.57	9.52±1.88^a
对照组	45	69.01±6.54	84.25±8.87^a	66.06±9.08	73.60±10.75^a	14.40±2.27	11.03±3.06^a
t值		0.380	6.307	0.110	3.828	0.117	2.820
P值		0.704	< 0.001	0.912	< 0.001	0.906	0.005
注：与同组治疗前比较，^aP < 0.05。

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表 3 2组CA-ROSC患者治疗前后血清S100β、MMP-9水平比较(x ±s，μg/L)

组别	例数	S100β		MMP-9
组别	例数	治疗前	治疗后	治疗前	治疗后
观察组	45	1.36±0.22	0.45±0.12^a	401.27±82.30	289.45±107.19^a
对照组	45	1.39±0.17	0.71±0.23^a	391.45±90.18	349.27±126.45^a
t值		0.723	6.723	0.539	2.420
P值		0.471	< 0.001	0.590	0.017
注：与同组治疗前比较，^aP < 0.05。

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表 4 2组CA-ROSC患者救治情况比较(x ±s)

组别	例数	脑复苏成功[例(%)]	脑复苏成功时间(d)	GCS评分(分)		CPC评分(分)
组别	例数	脑复苏成功[例(%)]	脑复苏成功时间(d)	治疗前	治疗后	治疗前	治疗后
观察组	45	38(84.44)	15.47±4.33	6.04±1.01	13.27±2.20^c	2.90±0.61	1.53±0.58^c
对照组	45	29(64.44)	18.45±5.01	6.02±1.34	11.05±2.01^c	2.99±0.58	2.27±0.35^c
统计量		4.730^a	3.018^b	0.079^b	4.997^b	0.717^b	7.327^b
P值		0.029	0.003	0.936	< 0.001	0.475	< 0.001
注：^a为χ²值，^b为t值。与同组治疗前比较，^cP < 0.05。

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