目的 研究生脈注射液治療急性心肌梗死后心源性休克的臨床療效。方法 選取2015年6月-2016年8月十堰市太和醫(yī)院治療的急性心肌梗死后心源性休克患者164例，隨機分為對照組和治療組，每組各82例，對照組給予常規(guī)治療，治療組在對照組的基礎(chǔ)上靜脈滴注生脈注射液，60 mL加入5%葡萄糖溶液250~500 mL，1次/d。兩組均連續(xù)治療7 d。治療后，觀察兩組患者臨床療效，同時比較血清心肌肌鈣蛋白I（cTnI）、鈣調(diào)蛋白（CaM）及其基因表達，心功能指標(biāo)左心室內(nèi)壓最大上升速率（dp/dt_max）、左心室內(nèi)壓最大下降速率（-dp/dt_max）、左室射血分數(shù)（LVEF）、舒張末期室間隔厚度（IVST）、左心室收縮末期內(nèi)徑（LVESD）、左心室舒張末期內(nèi)徑（LVEDD）、心臟指數(shù)（CI），及肺毛細血管楔壓（PCWP）、心率（HR）、收縮壓（SBP）、舒張壓（DBP）、脈壓（PP）和尿量（UV）的變化。結(jié)果 治療后，對照組和治療組總有效率分別為60.97%和74.39%，兩組總有效率比較差異有統(tǒng)計學(xué)意義（P<0.05）。兩組cTnI、CaM、cTnI-mRNA和CaMKII-mRNA均較治療前顯著降低，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05），且治療組上述指標(biāo)降低更明顯，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。兩組±dp/dt_max、LVEF和CI均升高、LVEDD增大，IVST和LVESD均縮?。?i>P<0.05），且治療組上述指標(biāo)改善更明顯（P<0.05）。兩組患者PCWP和HR均降低，SBP和DBP均升高，PP增大，UV增多（P<0.05），且治療組上述指標(biāo)改善更明顯（P<0.05）。治療組并發(fā)癥中室間隔穿孔、急性腎衰竭和心律失常和死亡率明顯低于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 生脈注射液治療急性心肌梗死后心源性休克療效顯著，糾正急性心肌梗死時心肌“鈣超載”現(xiàn)象，明顯增強心臟泵血功能，具有一定的臨床推廣應(yīng)用價值。

Objective To study the clinical effect of Shengmai Injection in treatment of cardiogenic shock (CS) after acute myocardial infarction (AMI), in order to provide the theoretical basis for clinical use. Methods Patients (164 cases) with cardiogenic shock after acute myocardial infarction in Shiyan Taihe Hospital from June 2015 to August 2016 were randomly divided into control and treatment groups, and each group had 82 cases. Patients in the control group were given conventional therapy. Patients in the treatment group were iv administered with Shengmai Injection on the basis of the control group, 60 mL added into 5% glucose injection 250-500 mL, once daily. Patients in two groups were treated for 7 d. After treatment, the efficacy was evaluated, and serum cardiac troponin I (cTnI), calmodulin (CaM) and the gene expression, cardiac function indexes left ventricular maximal rise rate (dp/dt_max), left ventricular maximal fall rate (-dp/dt_max), left ventricular ejection fraction (LVEF), interventricular septum thick (IVST), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and the amount of urine (UV) were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 60.97% and 74.39%, respectively, and there were differences between two groups (P<0.05). After treatment, cTnI, CaM, cTnI-Mrna, and CaMKII-mRNA in two groups were decreased, and there were significant differences between the same groups before and after treatment (P<0.05). And these indexes in treatment group were decreased more than those in the control group with significant differences (P<0.05). ±dp/dt_max, LVEF, CI, and LVEDD were increased, while IVST and LVESD were decreased (P<0.05). And these indexes in treatment group were improved more significantly than those in the control group (P<0.05). PCWP and HR were decreased, while SBP, DBP, PP, and UV were increased with significant differences (P<0.05). And these indexes in treatment group were improved more significantly than those in the control group (P<0.05). Ventricular septal rupture, acute renal failure, arrhythmia, and mortality rate in the treatment group were lower than those in the control group, and there were differences between two groups (P<0.05). Conclusion Shengmai Injection has a significant clinical efficacy in treatment of cardiogenic shock after acute myocardial infarction, can correct the myocardial calcium overload of AMI, and increase heart pump function obviously, which has a certain clinical application value.

湖北省教育廳教育科學(xué)“十二五”規(guī)劃課題（2014B095）