标题：磷酸肌酸钠联合酚妥拉明治疗重症肺炎伴心肌损伤的疗效及安全性

      作者：常亮 1，张涛 1，张丽 1，张晓明 1，姚晓雷 2    1.西安国际医学中心医院急诊科，陕西 西安 710100；2.陕西省第四人民医院检验科，陕西 西安 710043

      卷次： 2022年33卷13期

      【摘要】 目的 评价磷酸肌酸钠联合酚妥拉明治疗重症肺炎伴心肌损伤的疗效及安全性。方法 选取2019年5月至2020年5月在西安国际医学中心医院确诊的92例重症肺炎伴心肌损伤患者，采用简单随机方法将患者分为观察组和对照组，每组46例。对照组患者静脉滴注磷酸肌酸钠治疗，观察组采用磷酸肌酸钠联合甲磺酸酚妥拉明注射液治疗，两组患者均连续治疗两周。比较两组患者的临床疗效、治疗前后的血气指标[动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、血氧饱和度(SaO2)、酸碱度(pH)]、心肌酶指标[谷草转氨酶(AST)、乳酸脱氢酶(LDH)、磷酸肌酸激酶同工酶(CK-MB)]和血清炎症因子[肿瘤坏死因子-α (TNF-α)、白细胞介素-1 (IL-1)、IL-17、C-反应蛋白(CRP)]水平，并比较两组患者治疗期间的不良反应发生情况。结果 观察组患者的治疗总有效率为97.83%，明显高于对照组的86.96%，差异有统计学意义(P<0.05)；治疗后，两组患者的PaO2、SaO2、pH明显升高，PaCO2明显降低，且观察组患者的PaO2、SaO2和pH值明显高于对照组，PaCO2明显低于对照组，差异均有统计学意义(P<0.05)；治疗后，两组患者的血清AST、LDH、CK-MB、TNF-α、CRP、IL-17、IL-1水平均明显降低，且观察组患者的上述指标明显低于对照组，差异均有统计学意义(P<0.05)；观察组患者治疗期间不良反应发生率为6.52%，略低于对照组的13.04%，但差异无统计学意义(P>0.05)。结论 磷酸肌酸钠联合酚妥拉明治疗重症肺炎伴心肌损伤可有效改善患者的心肺功能，缓解心肌损伤和炎症水平，临床治疗效果显著且安全性较高。
      【关键词】 重症肺炎；心肌损伤；磷酸肌酸钠；酚妥拉明；炎症因子；血气指标；疗效
      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350（2022）13—1650—05

Effect and safety of creatine phosphate sodium combined with phentolamine in the treatment of severepneumonia complicated with myocardial injury.
CHANG Liang 1, ZHANG Tao 1, ZHANG Li 1, ZHANG Xiao-ming 1,YAO Xiao-lei 2. 1. Emergency Department, Xi'an International Medical Center Hospital, Xi'an 710100, Shaanxi, CHINA;2. Department of Clinical Laboratory, Shaanxi Fourth People's Hospital, Xi'an 710043, Shaanxi, CHINA
【Abstract】 Objective To evaluate the effect and safety of creatine phosphate sodium combined with phentol-amine in the treatment of severe pneumonia complicated with myocardial injury. Methods A total of 92 patients withsevere pneumonia and myocardial injury confirmed in Xi'an International Medical Center Hospital were enrolled be-tween May 2019 and May 2020. They were divided into an observation group and a control group by simple randomgrouping method, with 46 patients in each group. The control group was given intravenous drip of creatine phosphate so-dium, while the observation group was treated with creatine phosphate sodium combined with phentolamine mesylate in-jection. Both groups were continuously treated for 2 weeks. The clinical curative effect, blood gas indexes [partial pres-sure of arterial blood carbon dioxide (PaCO2), partial pressure of arterial blood oxygen (PaO2), blood oxygen saturation(SaO2), potential of hydrogen (pH)], myocardial enzyme indexes [aspartate aminotransferase (AST), lactate dehydroge-nase (LDH), creatine kinase isoenzyme (CK-MB)], serum inflammatory factors [tumor necrosis factor-α (TNF-α), inter-leukin-1 (IL-1), IL-17, C-reactive protein (CRP) before and after treatment, and the occurrence of adverse reactionswere compared between the two groups. Results There was no significant difference in clinical data between the twogroups (P>0.05). The total response rate of treatment in the observation group was significantly higher than that in con-trol group (97.83% vs 86.96%, P<0.05). After treatment, PaO2, SaO2, and pH were significantly increased, while PaCO2was significantly decreased in both groups, with statistically significant differences (P<0.05). PaO2, SaO2, and pH in the ob-servation group were significantly higher than those in the control group, while PaCO2 was significantly lower than that inthe control group, with statistically significant differences (P<0.05). After treatment, levels of serum AST, LDH, CK-MB,TNF-α, CRP, IL-17, and IL-1 in both groups were significantly decreased (P<0.05), and the levels in the observationgroup were significantly lower than those in the control group, with statistically significant differences (P<0.05). The inci-dence of adverse reactions during treatment in the observation group was slightly lower than that in the control group(6.25 % vs 13.04%), but the difference was not statistically significant (P>0.05). Conclusion Creatine phosphate sodiumcombined with phentolamine can effectively improve cardiopulmonary function, relieve myocardial injury and inflammationlevel in the treatment of severe pneumonia combined with myocardial injury, with few adverse reactions and high saf