| Cardiac arrest(CA)is an important cause threatening human life.Even if cardiac arrest is successfully resuscitated,it also comes up with organ injuries or failure after ischemia,hypoxia and reperfusion injury,which might induce Post Cardiac Arrest Syndrome(PCAS).The quality of PCAS treatment can seriously affect the prognosis and neurological function of patients.How to improve the success rate of cardiopulmonary resuscitation(CPR)and PCAS is a major problem in emergency medicine.Traditional Chinese medicine has a long history in the maintenance of organ function,especially the recovery of nerve function.Modern Chinese medicine has also made progress in treating critical diseases.Multiple internal and external treatments have been developed for treating PCAS.According to review of studies on treating PCAS,electroacupuncture at Baihui and Zusanli might have protection effect.In order to further explore the efficacy and mechanism of acupuncture at Baihui and Zusanli on PCAS,this study conducted a retrospective cohort study on PCAS cases.On this basis,a prospective randomized controlled study was conducted on patients with recovery of spontaneous circulation(ROSC)after rescue of in-hospital cardiac arrest(IHCA)to verify curative effect of electroacupuncture.Furthermore,an experimental research on PCAS rat model after CA-CPR by asphyxia method was carried out.Objective1.The PCAS cases after successful IHCA resuscitation were analyzed retrospectively.The patients were divided into two queues by whether acupuncture was performed or not.The curative effect of acupuncture on survival rate and organ function was analyzed.2.A prospective randomized controlled trial was conducted to evaluate whether electroacupuncture can improve the neurological function score,the success rate of cardiopulmonary cerebral resuscitation and the discharge success rate of patients with good neurological function.3.Evaluate the curative effect of electroacupuncture at Baihui and Zusanli on PC AS rat model and discussed its mechanism.Methods1.The successful cases of IHCA resuscitation according to the ustein registration from 2013 to 2019 were retrospectively analyzed.They were divided into acupuncture group and non-acupuncture group according to whether electroacupuncture intervention was carried out.The effects of electroacupuncture on the discharge success rate of good neurological function,neurological function score,28 day survival rate,various vital signs,critical degree score,organ function support and other indicators were observed.2.Patients with ROSC after IHCA were prospectively included and randomly divided into experimental group and control group.Both groups were given comprehensive treatment after resuscitation:routine western medicine treatment was given according to evidence-based medical evidence,including target temperature management,ventilation strategy,prevention and treatment of aspiration,rational use of antibiotics and other standard treatment schemes in the ICU;The experimental group was given comprehensive treatment after resuscitation+electroacupuncture,and electroacupuncture at Baihui+Zusanli was performed immediately after ROSC,with a waveform of density wave,frequency of 20/100Hz,and intensity of 1mA(initially,adjusted according to the patient’s situation),for 30 minutes,once per day,the course of treatment was 14 days or until death.The discharge success rate with good neurological function,ROSC maintenance,neurological function score,28 day survival rate,various vital signs,critical degree score,organ function support and other indicators were observed.3.The experimental rats were randomly divided into control group(sham group),model group(CA Group),Baihui group(GV20 group),Zusanli group(ST36 group)and Baihui+Zusanli group(GV+ST group).All rats underwent anesthesia,endotracheal intubation and arteriovenous catheterization.CA-CPR was not conducted in sham group;In CA Group,CA-CPR was performed after asphyxia to achieve ROSC,without electroacupuncture given after ROSC;The remaining three groups received electroacupuncture at the corresponding acupoints for 30min(density wave,acupuncture current intensity of 0.1-1mA,with visible muscle fibrillation,frequency of 20/100Hz)after ROSC.hemodynamic changes after ROSC was observed,the levels of blood lactic acid and arterial blood gas were detected.Some rats were randomly selected for 72 hour survival analysis,and the other rats were randomly divided into groups to detect the contents of serum catecholamine,epinephrine(EPI),norepinephrine(NA)and dopamine(DA)at 6h and 24h;At 6h and 24h,the heart and brain tissues were taken,the apoptosis was detected by deoxyncleotide terminal transferase(TDT)-mediated dUTP nick end labeling(TUNEL),and the number of cardiomyocytes was observed by hematoxylin eosin(HE)staining;Nissl staining was performed on the brain,neuronal quantification and pathological score,neurological defect score(NDS),etc.Results1.Results of retrospective cohort study:(1)By reviewing retrospective cohort study,acupuncture has no negative impact on the discharge success rate of good neurological function,neurological function score,28 day survival rate,various vital signs,critical degree score,organ function support,etc.(P>0.05);(2)However,the acupuncture group showed a higher stable proportion of ROSC and survival discharge rate.(P>0.05)2.Results of prospective randomized controlled trial:Electroacupuncture at Baihui and Zusanli had no negative effect on the discharge success rate of good neurological function,neurological function score,28 day survival rate,various vital signs,critical degree score and organ function support.(P>0.05)3.Results of animal experiment:(1)Electroacupuncture at Baihui and Zusanli has a certain stabilizing effect on hemodynamics after ROSC.Although there is no statistical difference,we can still see the slight advantage of electroacupuncture intervention on survival rate.(P>0.05)(2)Electroacupuncture at Baihui and Zusanli can improve the neural function of PCAS model rats,and the protective effect of combined Baihui+Zusanli on brain function is more obvious.Electroacupuncture at Baihui and Zusanli improved 6-hour NDS scores,especially when electroacupuncture at Baihui+Zusanli.In the 24-hour NDS score,electroacupuncture Baihui and Baihui+Zusanli showed a trend of better scores than the CA Group.Through the Nissl-stained average count of healthy neurons in the hippocampus,it can be seen that the neuron count of rats after electroacupuncture tends to be higher than that of rats in the CA group.The TUNEL measurement of the apoptosis rate of neuronal cells suggests that electroacupuncture has a repair effect on the neurons,but the rats in the CA group did not.In addition,the neuronal apoptosis rate of rats with electroacupuncture at Zusanli at 24h was reduced by nearly 29%compared with the CA group.The content of S100B in the brain function-related biomark ers of the CA group was significantly higher than that of rats treated with electroacupuncture.(P<0.05)(3)Electroacupuncture at Baihui and Zusanli had no significant effect on myocardial injury in CA-CPR PCAS model rats induced by asphyxia.(P>0.05)(4)Electroacupuncture at Baihui and Zusanli can up regulate the content of DA,so as to supplement the transmitter upstream of EPI and stabilize blood pressure,heart rate and anti-inflammatory.(P<0.05)Conclusion1.Clinical research(1)Acupuncture had no negative effect on discharge success rate,neurological function score,28 day survival rate,various vital signs,critical degree score and organ function support.However,the acupuncture group may have a higher stable proportion of ROSC and survival discharge rate.Electroacupuncture at Baihui and Zusanli may stabilize blood pressure and reduce the severity of disease,so as to improve the success rate of discharge.2.Animal experiment(1)Electroacupuncture at Baihui and Zusanli has a certain stabilizing effect on hemodynamics.However,electroacupuncture seems to have little effect on myocardial injury in this model,which may be related to the model’s injury to the myocardium and the selection of acupoints.(2)Electroacupuncture at Baihui and Zusanli can improve the neurological function of PCAS model rats,combined with Baihui+Zusanli,the protective effect of brain function changes is more obvious.(3)Electroacupuncture at Baihui and Zusanli can up regulate the content of DA,so as to supplement the transmitter upstream of EPI,which may be the reason why electroacupuncture can stabilize blood pressure,heart rate and anti-inflammatory in PCAS rat model.In addition,DA can also stimulate and reduce anxiety and depression.Therefore,whether electroacupuncture can be used as an important means of rehabilitation treatment for patients with CA deserves further exploration. |
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