参麦注射液治疗急性ST段抬高型心肌梗死合并心源性休克的疗效及机制研究

目的：探讨参麦注射液治疗急性ST段抬高型心肌梗死（STEMI）合并心源性休克（CS）的疗效及机制。方法：将STEMI合并CS（STEMI+CS）患者112例随机分为2组，即对照组和实验组，每组各56例。对照组患者实施常规治疗方案，实验组患者实施常规治疗联合参麦注射液治疗方案。观察2组患者治疗前后心功能评价指标，包括平均动脉压（MAP）、心排血量（CO）、左室射血分数（LVEF）、心脏指数（CI）、每搏输出量（SV）和心率（HR），血清心肌损伤标志物，包括乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK-MB）、天门冬氨酸氨基转移酶（AST）、肌红蛋白（MYO）和心肌肌钙蛋白I（cTNI）以及血清氧化应激参数，包括丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH-Px）、过氧化氢酶（CAT）和超氧化物歧化酶（SOD）。结果：与治疗前相比，对照组和实验组患者分别经2种治疗方案治疗后心功能评价指标MAP、CO、LVEF、CI和SV均显著增加（P<0.01），HR均显著降低（P<0.01），血清心肌损伤标志物LDH、CK-MB、AST、MYO和cTNI均显著降低（P<0.01）。与对照组治疗后相比，实验组治疗后MAP、CO、LVEF、CI和SV分别增加了15%、7%、12%、12%和9%（P<0.01），HR降低了5%（P<0.01），血清LDH、CK-MB、AST、MYO和cTNI分别降低了9%、42%、28%、34%和25%（P<0.01），实验组治疗后效果要明显优于对照组治疗后效果。氧化应激参数结果显示，与对照组治疗前相比，对照组治疗后血清MDA、GSH-Px、CAT和SOD的含量无明显变化（P>0.05）；与实验组治疗前相比，实验组治疗后血清MDA含量显著降低（P<0.01），GSH-Px、CAT和SOD含量显著增加（P<0.01）。与对照组治疗后相比，实验组治疗后MDA降低了47%（P<0.01），GSH-Px、CAT和SOD分别增加了26%、42%和29%（P<0.01）。结论：参麦注射液能够改善STEMI+CS患者的心功能，降低血清心肌损伤标志物以及改善血清氧化应激参数，其效果明显优于常规治疗效果，参麦注射液改善STEMI+CS患者临床疗效的作用机制可能与其降低患者体内氧化应激水平有关。

Effect and mechanism study of Shenmai injection in treating acute ST-elevation myocardial infarction with cardiogenic shock

OBJECTIVE To explore effect and mechanism of Shenmai injection in treating acute ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS). METHODS Totlaly 112 patients with STEMI combined with CS (STEMI+CS) were randomly divided into control group and experimental group, 56 cases in each group. The patients in the control group were given routine treatment. The patients in the experimental group were treated with routine treatment combined with Shenmai injection. The indexes of heart function including mean arterial pressure (MAP), cardiac output (CO), left ventricular ejection fraction (LVEF), cardiac index (CI), stroke volume (SV) and heart rate (HR); serum markers of myocardial injury including lactate dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST), myoglobin (MYO) and cardiac troponin I (cTNI) and serum oxidation stress parameters including malondialdehyde (MDA), glutathione peroxidase (GSH-Px), catalase (CAT), and superoxide dismutase (SOD) before and after treatment in two groups of patients were observed. RESULTS Compared with values before treatment, the MAP, CO, LVEF, CI, and SV of the heart function of the control group and the experimental group were significantly increased (P<0.01), and the HR was significantly lower (P<0.01). LDH, CK-MB, AST, MYO, and cTNI in serum markers of myocardial injury were all significantly lower (P<0.01). Compared with the control group after treatment, MAP, CO, LVEF, CI, and SV in the experimental group increased by 15%, 7%, 12%, 12%, and 9%, respectively (P<0.01), and HR decreased by 5% (P<0.01), serum LDH, CK-MB, AST, MYO, and cTNI decreased by 9%, 42%, 28%, 34%, and 25%, respectively (P<0.01). The effect of the experimental group after treatment was significantly better than that of the control group after treatment. The results of oxidative stress parameters showed that, the levels of MDA, GSH-Px, CAT and SOD in the control group did not change significantly after treatment compared with the control group before treatment (P>0.05). Compared with the experimental group before treatment, the serum MDA level in the experimental group was significantly lower after treatment (P<0.01); GSH-Px, CAT and SOD contents increased significantly (P<0.01). Compared with the control group after treatment, MDA in the experimental group decreased by 47% (P<0.01), GSH-Px, CAT and SOD increased by 26%, 42% and 29%, respectively (P<0.01). CONCLUSION Shenmai injection can improve the heart function of patients with STEMI+CS, reduce serum markers of myocardial injury and improve serum oxidative stress parameters. The effect of Shenmai injection is obviously better than that of conventional treatment. The mechanism of Shenmai injection improving the clinical efficacy of patients with STEMI+CS may be related to the decrease of oxidative stress in patients.