目的 探討參附注射液對(duì)急性心肌梗死（AMI）并發(fā)低血壓狀態(tài)患者多糖包被（EG）的影響。方法 選擇2021年6月—2022年12月哈勵(lì)遜國(guó)際和平醫(yī)院收治的AMI并發(fā)低血壓患者180例，用簡(jiǎn)單隨機(jī)數(shù)字表法分為對(duì)照組和試驗(yàn)組，每組各90例。對(duì)照組給予常規(guī)液體復(fù)蘇、抗血小板聚集、抗凝、調(diào)脂治療，同時(shí)給予多巴胺注射液持續(xù)泵入，將血壓控制在90 mmHg/60 mmHg（1 mmHg＝133 Pa）；試驗(yàn)組在對(duì)照組基礎(chǔ)上加用參附注射液100 mL＋0.9%氯化鈉注射液500 mL靜脈滴注，治療3 d。分別于治療前、治療3 d后，檢測(cè)血常規(guī)、高密度脂蛋白膽固醇（HDL-C）、N末端B型腦鈉尿肽（NT-proBNP）、可溶性腫瘤因子2抑制劑（sST2）、C反應(yīng)蛋白（CRP）、白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）、內(nèi)皮素-1 （ET-1）、一氧化氮（NO）、多配體蛋白聚糖-1 （SDC-1）、透明質(zhì)酸（HA）、硫酸類肝素（HS）、血栓調(diào)節(jié)蛋白（TM）水平。觀察并記錄入院后24、48、72 h平均收縮壓、尿量、心功能情況，評(píng)估低血壓狀態(tài)治療效果。觀察患者30 d內(nèi)惡性心血管事件的發(fā)生情況。結(jié)果 試驗(yàn)組總有效率（93.33%）顯著高于對(duì)照組（81.10%），差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。試驗(yàn)組在入院后24 h平均收縮壓、尿量已經(jīng)顯著高于對(duì)照組（P＜0.05）；試驗(yàn)組使用多巴胺時(shí)間比對(duì)照組縮短，使用多巴胺的總量低于對(duì)照組，改善預(yù)后藥物使用時(shí)間短于對(duì)照組（P＜0.05）。治療前，兩組患者中性粒細(xì)胞與淋巴細(xì)胞比值（NLR）、單核細(xì)胞與HDL-C比值（MHR）、CRP、IL-6、TNF-α、SDC-1、HA、HS、TM、ET-1、NO、NTproBNP、sST2、左心室舒張末期內(nèi)徑（LVEDD）、左室射血分?jǐn)?shù)（LVEF）比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。治療后，兩組患者NLR、MHR、CRP、IL-6、TNF-α、SDC-1、HA、HS、TM、ET-1、NT-proBNP、sST2、LVEDD均低于本組治療前，NO、LVEF高于本組治療前，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；試驗(yàn)組NLR、MHR、CRP、IL-6、TNF-α、SDC-1、HA、HS、TM、ET-1、NT-proBNP、sST2、LVEDD低于對(duì)照組，NO、LVEF高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05、0.01）。AMI并發(fā)低血壓患者，SDC-1與NLR、MHR、CRP、IL-6、TNF-α、NT-proBNP呈正相關(guān)；與LVEF呈負(fù)相關(guān)。ROC結(jié)果示，SDC-1對(duì)AMI并發(fā)低血壓患者30 d內(nèi)死亡風(fēng)險(xiǎn)有一定的預(yù)測(cè)價(jià)值，曲線下面積為0.824。結(jié)論 參附注射液能夠減輕AMI并發(fā)低血壓狀態(tài)患者EG的脫落，保護(hù)血管內(nèi)皮細(xì)胞，升高患者血壓。

Objective To investigate the effect of Shenfu Injection on polysaccharide encapsulation (EG) in patients with acute myocardial infarction (AMI) complicated by hypotension. Method A total of 180 patients with AMI complicated with hypotension admitted to Harrison International Peace Hospital from June 2021 to December 2022 were selected and divided into a control group and an experimental group using a simple random number table method, with 90 patients in each group. The control group was treated with routine liquid resuscitation, antiplatelet aggregation, anticoagulation, and lipid-lowering therapy, while dopamine injection was continuously pumped in to control blood pressure at 90/60 mmHg (1 mmHg = 133 Pa). The experimental group received intravenous infusion of 100 mL of Shenfu Injection and 500 mL of 0.9% Sodium Chloride Injection on the basis of the control group for three days. Blood routine, high-density lipoprotein cholesterol (HDL-C), N-terminal B-type brain natriuretic peptide (NT-proBNP), soluble tumor factor 2 inhibitor (sST2), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were detected before and three days after treatment, respectively. Levels of endothelin-1 (ET-1), nitric oxide (NO), multi ligand proteoglycan-1 (SDC-1), hyaluronic acid (HA), heparin sulfate (HS), and thrombomodulin (TM) were detected before and three days after treatment, respectively. Observe and record the average systolic blood pressure, urine volume, and cardiac function at 24, 48, and 72 hours after admission, and evaluated the treatment effect of hypotension. Observe the occurrence of malignant cardiovascular events in patients within 30 days. Results The total effective rate of the experimental group (93.33%) was significantly higher than that of the control group (81.10%), with a statistically significant difference (P < 0.05). The average systolic blood pressure and urine output in the experimental group were significantly higher than those in the control group 24 hours after admission (P < 0.05). The duration of dopamine use in the experimental group was shorter than that in the control group, and the total amount of dopamine used was lower than that in the control group. The use of drugs to improve prognosis was earlier than that in the control group (P < 0.05). Before treatment, there was no statistically significant difference in two groups of NLR, MHR, CRP, IL-6, TNF-α, SDC-1, HA, HS, TM, ET-1, NO, NT-proBNP, sST2, LVEDD, and LVEF (P > 0.05). After treatment, patients' NLR, MHR, CRP, IL-6, TNF-α, SDC-1, HA, HS, TM, ET-1, NT-proBNP, sST2, LVEDD were lower than before treatment in this group, while NO and LVEF were higher than before treatment in this group, with statistically significant differences (P < 0.05). Experimental groups, NLR, MHR, CRP, IL-6, TNF- α, SDC-1, HA, HS, TM, ET-1, NT-proBNP, sST2, LVEDD were lower than the control group, while NO and LVEF were higher than the control group, with statistically significant differences (P < 0.05, 0.01). SDC-1 and NLR, MHR, CRP, IL-6, TNF- α, NT-proBNP in patients with AMI complicated by hypotension, shows a positive correlation. There was a negative correlation with LVEF. The ROC results showed that SDC-1 has certain predictive value for the risk of death within 30 days in patients with AMI complicated by hypotension, with an area under the curve of 0.824. Conclusion Shenfu Injection can alleviate the shedding of EG in patients with AMI complicated by hypotension, protect vascular endothelial cells, and increase blood pressure in patients.

R972

2021年度河北省醫(yī)學(xué)科學(xué)研究課題項(xiàng)目（20210910）