Clinical efficacy of ulinastatin combined with naloxone in patients with cardiogenic shock after acute myocardial infarction

Abstract

Objective To study clinical efficacy of ulinastatin combined with naloxone in patients with cardiogenic shock(CS) after acute myocardial infarction (AMI).Methods Eighty patients with CS after AMI were randomly divided into routine treatment group (n =19),ulinastatin group (n =20),naloxone group (n =21) and ulinastatin combined with naloxone group (n =20).The levels of serum cardiac troponin I (cTnI),brain natriuretic peptide(BNP),tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6)were measured before and a week after treatment.In the meantime,recovery time of shock,the average hospitalization days and 28-day mortality rate were recorded.Results After the treatment,the levels of serum cTnI,BNP,TNF-α and IL-6decreased in all groups(P ＜ 0.01),and there was significant difference on the decreasing degree of cTnI,BNP,TNF-α and IL-6 in ulinastatin combined with naloxone group when compared with those in routine treatment group,ulinastatin group and naloxone group(cTnI:(1.04 ± 0.17) ng/L vs.(2.06 ± 0.15) ng/L,(1.59 ± 0.16)ng/L,(1.97 ± 0.14) ng/L; BNP:(143.21-56.94) ng/L vs.(261.07 ± 71.43) ng/L,(203.46 ± 65.73) ng/L,(252.96 ± 68.85) ng/L; TNF-α:(13.42 ± 8.93) ng/L vs.(31.21 ± 12.32) ng/L,(20.39 ± 11.08) ng/L,(28.98 ± 11.76) ng/L ; IL-6:(37.58 ± 11.14) ng/L vs.(80.46 ± 27.15) ng/L,(59.84 ± 20.72) ng/L,(76.15 ±26.45) ng/L; P ＜ 0.01).The recovery time of shock,the average hospitalization days and 28-day mortality rate in ulinastatin combined with naloxone group were significantly lower than those in routine treatment group,ulinastatin group and naloxone group(recovery time of shock:(7.16 ± 1.52) d vs.(11.43 ± 2.40) d,(8.05 ±1.81)d,(8.74 ± 1.98)d;the average hospitalization days:(15.03 ±3.23)d vs.(22.64 ±4.18)d,(18.93 ±3.97)d,(19.21 ±3.94)d ;28-day mortality rate:(41.62％ vs.61.20％,50.74％,52.31％ ; P ＜0.01)).Conclusion The application of ulinastatin combined with naloxone can effectively inhibit the cardiac injury and inflammatory response,promote the recovery of circulation function and improve prognosis in patients with CS after AMI. Key words: Ulinastatin; Naloxone; Acute myocardial infarction; Cardiogenic shock