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目的探讨参附注射液治疗心脏骤停(cardiac arrest,CA)患者脑复苏后血清神经元特异性烯醇化酶(NSE)和S-100B蛋白的变化,评价其对预后的影响。方法将106例浙江省人民医院收治的心脏骤停后出现自主循环恢复的患者分为2组,每组53例。对照组采用常规脑复苏治疗,保持机体低亚温。治疗组在对照组基础上,给予参附注射液治疗。于心肺复苏后0.5、2、12、24 h,采用酶联免疫吸附法检测2组患者血清NSE和S-100B蛋白的水平。于心脏骤停后12、24、48、72 h检测2组患者脑氧代谢指标水平;采用格拉斯哥昏迷量表(GCS)评估患者昏迷状态。记录2组患者复苏有效率及病死率。结果心肺复苏后,2组NSE、S-100B蛋白的水平均显著升高(P<0.05);心肺复苏后2、12、24 h,治疗组NSE、S-100B蛋白的水平均显著低于对照组同期的水平,差异有统计学意义(P<0.05);心脏骤停后12、24、48、72 h,2组患者动静脉血氧含量差(Ca-jv O_2)、脑氧摄取率(CERO_2)显著降低,颈静脉球部血氧饱和度(Sjv O_2)、GCS评分显著升高(P<0.05);心脏骤停后48、72 h,治疗组Ca-jv O_2、CERO_2、GCS评分显著高于对照组同期的水平,Sjv O_2显著低于对照组同期的水平,差异有统计学意义(P<0.05);治疗组有效率(67.92%)显著高于对照组(45.28%),病死率(69.81%)显著低于对照组(88.68%),差异有统计学意义(χ~2=5.530、5.736,P<0.05)。结论参附注射液能使心脏骤停患者脑复苏后的血清NSE、S-100B显著降低,有助于改善患者预后。
Objective To investigate the changes of serum neuron specific enolase (NSE) and S-100B protein in patients with cardiac arrest (CA) treated with Shenfu injection, and to evaluate its effect on prognosis. Methods One hundred and six patients in Zhejiang Provincial People ’s Hospital were divided into two groups (53 cases in each group) with spontaneous circulation recovery after cardiac arrest. Control group using conventional cerebral resuscitation therapy to maintain the body hypothermia. The treatment group was given Shenfu injection on the basis of the control group. Serum NSE and S-100B protein levels were measured by enzyme-linked immunosorbent assay at 0.5, 2, 12, 24 h after cardiopulmonary resuscitation. The levels of cerebral oxygen metabolism in the two groups were detected at 12, 24, 48 and 72 h after cardiac arrest, and the coma was assessed by Glasgow Coma Scale (GCS). The recovery rate and mortality of two groups were recorded. Results After cardiopulmonary resuscitation, the levels of NSE and S-100B protein in both groups were significantly increased (P <0.05). At 2, 12 and 24 h after CPR, the levels of NSE and S-100B in the treatment group were significantly lower than those in the control (P <0.05). At 12, 24, 48 and 72 h after cardiac arrest, the arterial-venous blood oxygen content difference (Ca-jv O 2) (P <0.05). At 48 and 72 h after cardiac arrest, the scores of Ca-jv O 2, CERO 2 and GCS in the treatment group were significantly higher than those in the control group (P <0.05). The effective rate (67.92%) in the treatment group was significantly higher than that in the control group (45.28%), and the mortality was significantly higher than that in the control group (69.81%) was significantly lower than the control group (88.68%), the difference was statistically significant (χ ~ 2 = 5.530,5.736, P <0.05). Conclusion Shenfu injection can significantly reduce serum NSE and S-100B levels after brain resuscitation in patients with cardiac arrest, which may help to improve the prognosis of patients.