| Background Acute Heart Failure(AHF)is a clinical syndrome refers to the acute onset and/or exacerbation of heart failure and characterized by acute new onset or acute decompensated chronic heart failure.Heart failure is the end phase of various heart diseases.Severe heart failure is accompanied by the renal hypoperfusion,this condition can lead to renal failure,and renal failure also is the inducement of heart failure.Clinically,such causal relationship between the two is known as cardiorenal syndrome[1].Moreover,renal dysfunction can obscure the clinical manifestations of heart failure and leading to misdiagnosis or leak diagnosis.Renal insufficiency is also the significant factor affecting the prognosis of heart failure.In recent years,with the increasing degree of aging of China’s social population and the improvement of people’s living standards,this all promotes the incidence of coronary heart disease,high blood pressure,and relevant cardiovascular diseases.On the one hand,the development of medical level makes the survival rate of patients with such heart disease rise substantially.On the other hand,however,it also leads to incidence of heart failure are increasing year by year.The 5-year survival rate of heart failure is only about 50%,which is equal to that of malignant tumors.Therefore,heart failure is known as “the last battlefield and unconquered fortress of cardiovascular diseases in the 21 st century”[2].Even though there are continuous research and development for new drugs(eg.ivabradine,angiotensin receptor encephalin enzyme inhibitors(ARNI)etc.),to some extent,it can improve the prognosis of patients with heart failure.Nevertheless,due to the drug’s own limitations,individual’s differences of patience,the mortality of heart failure remains high.Therefore,we try to explore the different approach in the perspective of traditional Chinese medicine.The traditional Chinese medicine research has accumulated rich experience in the heart failure area.Some of Chinese medicine applied in the adjuvant treatment of heart failure has been proved to be reliable,effective and relatively safe,such as Qi Li Qiang Xin capsule[3].Furthermore,regarding the Shenmai injection,the main component of this injection includes Ginseng and radix ophiopogonis.Studies have found that ginseng and radix ophiopogonis can improve circulation and have a protective effect on the body.Consequently,the purpose of this study is to observe the clinical efficacy of basic therapy in anti-heart failure combine with shenmai injection,thus may provide new idea in guiding clinical treatment of heart failure furtherly.Purpose Initially,to observe the clinical efficacy of Shenmai injection for the AHF patients complicated with renal insufficiency.Moreover,to analyze and discuss the effect of Shenmai injection on the cardiac function,renal function as well as inflammatory factors in the AHF patients those are complicated with renal insufficiency.Data collection and sampling The sample size is selected 123 AHF patients complicated with renal insufficiency in the cardiovascular medicine department of the First Affiliated Hospital of Zhengzhou University during the December 2016 to October,2017.Patient has been randomly dividend into Shenmai group(n=63),and control group(n=60).Patients in both groups were given bed rest,low-salt and low-fat diet,and NYHA classification were evaluated within 12 hours of admission.Both groups have been treated with diuretics,cardiac enhancers,catheters expanders,as well as drugs for improving ventricular remodeling.Except of conventional drugs,Shenmai group has added Shenmai injection(Its main ingredients are red ginseng and radix ophiopogonis)50ml into 5% glucose injection 250 ml,intravenous drip,applied once a day for two weeks.Before the treatment and after drugs had been applied for two weeks,we have recorded the clinical efficacy and adverse reactions of two groups.In the meanwhile,plasma soluble inflammatory cytokines(s ST2),interleukin-6(IL-6),hs-CRP,interleukin-10(IL-10),NT-pro BNP,cystatin C,c Tn T and c Tn I have been detected in both groups.The index assessment of left ventricular ejection fraction(LVEF),stoke volume(SV),Left ventricular end diastolic volume(LVEDD)also been collected in both groups.Results After the treatment and compared with the control group:1.The NYHA classification had a better improvement in Shenmai group(Z=-2.333,p=0.020);Results differences between the two groups of patients with statistical significance.2.The plasma levels of NT-pro BNP、c-Tn I、c Tn IT、LVEDD were decreased,and the decreased rate of Shenmai group was higher compared with control group(P<0.05).There was an increase trend of LVEF and SV,the increased level of Shenmai group also higher than the control group(p<0.05).3.In the control group,there was no significant change in Cr after the treatment[(110.8±26.19)vs(118.8±30.15)] μmol/L,(p>0.05).For the Shenmai group,the Cr was significantly reduced compared with that before treatment(p<0.05).Cr of Shenmai group was distinctly lower than the control group.After the treatment,Cysc has decreased in both of groups(p<0.05),decreased level of Shenmai group is higher than the control group(p<0.05).4.The plasma IL-6 in both groups has decreased,the decreased level of Shenmai group was higher than the control group(p<0.05).IL-10 was increased,the increased level of Shenmai group was higher than the control group(p<0.05),In the control group,there was no significant change in s ST2 after the treatment[(0.41±0.07)vs(0.44±0.09)ng/ml.The s ST2 of Shenmai group was decreased distinctly after the treatment,and decreased level of Shenmai group was higher than the control group(p<0.05).After the treatment,the hs-CRP in control group has no significant changes [(9.13±2.03)vs(10.24±4.67)] pg/ml,(p>0.05).On the contrary,the hs-CRP of Shenmai group was decreased obviously.The decreased level of Shenmai group was higher than the control group(p<0.05).Conclusion1.Shenmai injection can improve the cardiac function of patients with acute heart failure and renal insufficiency.2.Shenmai injection can improve renal function in patients with acute heart failure and renal insufficiency.3.Shenmai injection can reduce the level of pro-inflammatory factors and increase the level of anti-inflammatory factors,so as to play an anti-heart failure effect. |
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