参附注射液对急性百草枯中毒心肌损伤的影响

目的探讨急性百草枯中毒（APP）患者应用参附注射液治疗前后和肽素（Copeptin）水平的变化。方法选择河北医科大学附属哈励逊国际和平医院急诊科2011年7月-2014年7月收治的APP患者68例,随机分成常规组和治疗组,各34例。入院后尽早给予洗胃、催吐、导泻,常规组给予血液灌流、清除自由基、环磷酰胺联合糖皮质激素冲击疗法等综合治疗。治疗组在常规组基础上加用参附注射液50 mL,静滴,1次/d,疗程3 d。所有患者入院后2h内（患者中毒后4 h内）、6h、3d抽取静脉血3 m L,检测Copeptin、肌钙蛋白Ⅰ（cTnⅠ）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）水平。结果治疗组与常规组总有效率分别为97.06%和70.59%,差异有统计学意义（P〈0.05）。入院后2 h,两组Copeptin、cTnⅠ、CK、CK-MB水平比较差异无统计学意义（P〉0.05）。但Copeptin水平高于参考范围。入院后6 h,常规组Copeptin、cTnⅠ、CK、CK-MB水平高于治疗组,差异有统计学意义（P〈0.05）。入院后3 d,Copeptin、CK、CK-MB恢复到正常范围,两组比较差异无统计学意义（P〉0.05）。但常规组cTnⅠ水平高于治疗组,差异有统计学意义（P〈0.05）。结论 APP患者早期应用参附注射液对心肌确有保护作用,对提高患者治疗率有重要的临床价值。

Effects of Shenfu Injection on myocardial injury in acute paraquat poisoning

Objective To investigate the changes of copeptin level before and after treatment for patients with acute paraquat poisoning（APP）. Methods 68 patients with APP admitted to Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from July 2011 to July 2014 were chosen and randomly divided into conventional group and treatment group, with 34 cases in each group. After admission, gastric lavage, emetic,cathartic treatment were given immediately, the conventional group received hemoperfusion, anti free radical scavenging, pulse therapy of cyclophosphamide and glucocorticoid and other comprehensive treatments. Based on the conventional group, the treatment group was added with Shenfu Injection 50 mL, intravenous drip, once a day, 3 days were as a course. All patients received extraction of venous blood 3 mL within 2 h after admission（4 h after poisoning）, 6 h, 3d, and the levels of copeptin, cTn Ⅰ, CK, CK-MB were detected. Results The total effective rate of treatment group and the conventional group was 97.06% and 70.59% respectively, there was a significant difference between the two groups（P〈0.05）. 2 hours after admission, there were no significant differences in copeptin, cTnⅠ, CK, CK-MB levels between the two groups（P〉0.05）. But the copeptin levels were above the reference range. 6 hours after admission, the levels of copeptin, cTnⅠ, CK, CK-MB in conventional group were higher than those in the treatment group, there were significant differences（P〈0.05）. 3 days after admission, copeptin, CK, CK-MB returned to normal, there were no significant differences between the two groups（P〉0.05）. But the level of cTn Ⅰ in the conventional group was higher than that of treatment group, the difference was statistically significant（P〈0.05）. Conclusion Early application of Shenfu Injection in APP patients has a protective effect for myocardium, which has an important clinical value in improving the curative rate.