The Study On Protective Effect Of Sepsis Induced Myocardial Injury With Jia Wei Shen Fu Particles

Sepsis is one of the clinical common critical disease,Its incidence is growing at 1.5% a year,Despite critical medicine in nearly 10 years developed rapidly,especially the organ function support technology and anti-infection treatment have made a great progress,but the mortality of sepsis remains as high as 30%-70%,become one of the main cause of death in critical patients.myocardial injury is a common complication of sepsis and the important factors that affect the sepsis outcome,according to statistics,if sepsis patients with cardiovascular complications,patients will be deteriorated sharply,and the case fatality rate can be increased by 30% to70% ~ 90%.Therefore,To conduct in-depth research and early prevention and control of the pathogenesis of sepsis myocardial injury,and to improve the treatment level of sepsis is of great significance.Jia Wei Shen Fu particles is a traditional chinese medicine compound preparation of guangdong second hospital of TCM.this preparation is made up of red ginseng,lateral root,tuckahoe,notoginseng,etc of drugs.It has the effects of warming yang and tonifying qi,activating blood and promoting diuresis.According to a large number of experimental and clinical research,It have been confirmed that Jia Wei Shen Fu particles can enhance the myocardial contraction force,improve the cardiac output,reduce the systemic peripheral resistance,inhibit the cardiac remodeling and improve left ventricular pressure and left ventricular end-diastolic pressure,reducing left ventricular afterload,and improve its neuroendocrine,and significantly improve cardiac function and clinical symptoms,reduce hospital readmission rate and improve survival rate and survival quality.Therefore,Through Jia Wei Shen Fu particles used in sepsis myocardial injury,it will provide a new way for prevention and control of sepsis myocardial injury due to observation of its protective effect on myocardial injury.The first part Experiment Research Objective:Through experimental research,To observe the impact on sepsis myocardial injury in rats by Jia Wei Shen Fu particles,To explore the possible mechanisms of myocardial protection in rats,To do basic research of Jia Wei Shen Fu particles in the treatment of sepsis.Methods:SD rats were randomly divided into sham-operated group(sham group),sepsis model group(sepsis group),Jia Wei Shen Fu particles treatment group(JWSF group),each group is divided into 6 hours,24 hours,48 hours three point subgroups,including sham group each group of four,sepsis group and JWSF each subgroup are 6 in rats.Groups of rats were normal feeding,JWSF group were began to fill the stomach a week before operation,The other two groups were continued to the normal feeding.sepsis models were established through intraperitoneal injection of lipopolysaccharide in rats.the abdominal aortic blood were collected in rats of each group according to different point acquisition.and were tested index for troponin I,superoxide dismutase(sod),creatine kinase isoenzyme,B-type brain natriuretic peptide;The heart of rats were returned to do cardiac muscle tissue biopsies,to observe myocardial morphology by using the light microscope,to detect myocardial cell apoptosis by TUNEL staining.Results:1,Troponin I:there is no significant difference of cTnI levels between JWSF group rats in 6 hours?24 hours and sepsis group(P>0.05),but the cTnI levels of JWSF group in 48 hours in rats was lower than that in sepsis group(P<0.01),and no difference compared with the sham group(P>0.05).2,SOD:there is no significant difference of SOD levels between JWSF group rats in 6 hours and sepsis group(P>0.05),but the SOD levels of JWSF group in 24 hours?48 hours in rats was higher than that in sepsis group(P<0.01).3,CK-MB:there is no significant difference of CK-MB levels between JWSF group rats in 6 hours and sepsis group(P>0.05),but the CK-MB levels of JWSF group in 24 hours?48 hours in rats was lower than that in SEPSIS group(P<0.01),and no difference compared with the sham group(P>0.05).4,BNP:there is no significant difference of BNP levels between JWSF group rats in 6 hours and sepsis group(P>0.05),but the BNP levels of JWSF group in 24 hours?48 hours in rats was lower than that in sepsis group(P<0.01).5,Observation by using light microscope:sham group:Myocardial fibers were arranged neatly,myocardial cell dyeing was uniform,nuclear lobes in the middle like ovoid,Its interstitial blood vessels were not expand or narrow,and no inflammatory cell infiltration.sepsis group:Myocardial fibers were arranged disorderly,It was found that myocardial cell edema,interstitial focal hemorrhages,lymphocyte infiltration.The myocardial cell damage degree of JWSF group in 24 hours was reduced significantly,the myocardial cell edema,hemorrhage,lymphocyte infiltration of JWSF group in 48 hours were further reduced.6,TUNEL staining: there is no significant difference of myocardial cell apoptosis between JWSF group rats in 48 hours and sham group(P>0.05),but the myocardial cell apoptosis was lower than the sepsis group(P<0.01).Conclusion:1,Jia Wei Shen Fu particles can reduce the myocardial damage of sepsis in rats induced by endotoxin,make the protective effects on myocardial injury of sepsis.2,The protective mechanism of myocardial of Jia Wei Shen Fu particles in sepsis rats caused by endotoxin may be related to reducing oxidative stress,protecting heart function,inhibiting myocardial apoptosis.The second part Clinical Research Objective:Through clinical research,To observe the impact on sepsis myocardial injury patients by Jia Wei Shen Fu particles,To explore the possible mechanisms of myocardial protection in patients,To expand application and research of Jia Wei Shen Fu particles in the treatment of sepsis.Methods:71 patients with sepsis myocardial injury(yang deficiency or qi deficiency in TCM differentiation)were allocated randomly into two groups:Jia Wei Shen Fu particles observation group(37 cases)and control group(34 cases),The control group was used with conventional western medicine treatment,including anti-infection,fluid resuscitation,organ support measures,but observation group was added with Jia Wei Shen Fu particles on the basis of conventional western medicine,observation was made on finding the effects of TCM syndrome,the influence of the myocardial injury index and critical score(APACHE ?).Results:1,myocardial marker:(1)Troponin I: The cTnI levels of JWSF group in 4 days and 7 days after treatment were lower than the control group,The comparison was statistically significant(P<0.01).(2)SOD: The SOD levels of JWSF group in 4 days and 7 days after treatment were higher than the control group,The comparison was statistically significant(P<0.01).(3)BNP: The BNP levels of JWSF group in 4 days and 7 days after treatment were lower than control group,The comparison was statistically significant(P<0.01).(4)CK-MB: The CK-MB levels of JWSF group in 4 days and 7 days after treatment were lower than the control group,The comparison was statistically significant(P<0.01).2,APACHE ? score: The APACHE ? score of JWSF group in 4 days and 7 days after treatment were lower than control group,The comparison was statistically significant.(P<0.01).3,TCM syndrome score:(1)The Yang deficiency score of the observation group after treatment 4 days,after 7 days were lower than the control group,The comparison was statistically significant(P<0.01).(2)The Qi deficiency score of the observation group after treatment 4 days,after 7 days were lower than the control group,The comparison was statistically significant(P<0.01).4,clinical effect: After treatment 7 days:The obvious effect of the observation group was better than that of the control group(P<0.05),but no statistical significance in terms of the total effectiveness(P>0.05).Conclusion:1,Jia Wei Shen Fu particles can significantly reduce the myocardial damage in patients with sepsis(yang deficiency or qi deficiency in TCM differentiation),make the protective effects on myocardial injury of sepsis.2,Jia Wei Shen Fu particles significantly reduce the TCM syndrome score in patients with sepsis(yang deficiency or qi deficiency in TCM differentiation),the clinical curative effect is distinct,it will improve the prognosis of patients.