The Clinic Study Of The Protective Effect Of Sheng Mai Injection On Myocardial Ischemic Reperfusion Injury In CPR

Cardiac arrest is one of the most serious emergency cases,it hasa high fatality rate, regardless cardiogenic cases or non-cardiogeniccases.Recent research has testified that :when someone happenedcardiac arrest,the blood flow of body was discontinued.Then plentyof oxygen free radicals produced.When the tissue have beenrecovered the blood,the metabolismic function obstructed andconstruction destructed in the cells have became more serious.Thephenomenon has been named ischemia reperfusion injury.Themechanism of myocardial reperfusion injury which is known areoxygen free radicals and calcium overload and so on. Thoughtreatment to CA according《CPR and emergency cardiovascular careguidelines 2000》,most of patients died of all kinds of criticalcomplications. How to protect the ischemic myocardia moreeffectively and reduce the morbidity of complications is veryimportant to decrease the clinical mortality of CA.In theexperimental research ,we choose Shengmai Injection to treatmentthe patients of CA who have accepted CPR,observing successfulrate,exploring the theoretic basis and the practice experience in theconservative treatment of myocardial ischemia reperfusion injury.SMI is the high efficiency extract of the tradition Chinesemedicine Shengmai-san (also called Shengmai-yin) by mordenpharmaceutical technology .The composition of SMI are ginseng,ophopogonis and Chinese magnoliavine fruit.The proportion ofcomposition of medicines is 1:.3.12:1.56.The research on SMI'spharmacology in many files have been proved that SMI can increasethe blood stream amount of coronary artery,protect ischemicmyocardium,get rid of OFR and prevent cell lipid peroxidationreaction,improve ultrastructure of myocardium,increase cardiacoutput,inhibit blood clotting,restrain platelet adhesion andaggregation,degrade blood viscosity,arise blood pressure anddecrease the incidence of arrhythmia.Method:There is 40 cases enrolled in the research .All the casesthose happened cardiac arrest and have recovered heart beat(≥24h)through CPR were randomly divided into two groups.20 cases inSMI group and 20 cases in control group.The patients in two groupswere treated with common therapeutics based on the《CPR andemergency cardiovascular care guidelines 2000》,and the cases inthe SMI group were intravenously dropped with SMI in the earlyperiod of PLS phase.The general data of two groups including age,sex,the time from morbidity to treatment and the degree of severityhave no significant difference.The agent of CA includes cardiogeniccases and non-cardiogenic cases.The most of cardiogenic cases areAMI and fatality arrhythmia.,the non-cardiogenic cases includesdrug poisoning,electrical injury,shock,stoke and so on .Beforeresuscitation and 60 minutes after resuscitation ,haemospasia at ulnarvein. Assay the blood serum concentration of SOD,MDA,TNF,IL-8 and CK-MB in SMI group, control group and healthycomparison group.Compare the successful rate of CPR at differenttime between SMI group and control group;Compare the successfulrate of CPR in two groups after CA of various factors;Compare theincidence rate of reperfusion arrhythmia in two groups afterCPR;Compare the dynamic change of CK-MB,MDA,SOD,TNFand IL-8 before resuscitation and 60 minutes after resuscitation intwo groups;Monitor the change of electrocardiogram in the wholetreatment.Result :1.The successful rate of CPR was highest in the patientsthose who started CPR within 5 minutes after CA.The second was at6~10 minutes.At 11~15 minutes there is no revival in twogroups.The successful rate of SIM group at each time was higherthan that of control group(P<0.05).2.The successful rate of CPR inSIM group after CA of various factors was 60%(12/20 cases),it wassignificantly higher than that of control group (45%,9/20cases).(P<0.05).3.The incidence rate of reperfusion arrhythmia inSMI group was 45%,it was significantly lower than that of controlgroup (70%,P<0.05).4.The serum concentration levels of SOD in thetwo groups (before resuscitation and after resuscitation) were lowerthan healthy comparison group(P<0.01).At 60 minutes afterresuscitation,the levels of SOD in SMI group were higher thancontrol group(P<0.01). The serum concentration levels of MDA ,TNF,IL-8 and CK-MB in the two groups (before resuscitation) werehigher than healthy comparison group(P<0.01). There was nosignificant difference in the levels of MDA ,TNF,IL-8 and CK-MBbetween two groups before resuscitation.At 60 minutes afterresuscitation the levels of MDA ,TNF,IL-8 and CK-MB in SMIgroup were lower than those of control group(P<0.01).Conclusion:1.Comparing SIM group to control group , thelevels of SOD significantly increased and the levels of MDAdecreased after resuscitation in SMI group. The research tells us that:SMI can get rid of OFR and prevent cell lipid peroxidation .2.Thelevels of TNF and IL-8 after resuscitation in SMI are lower thanthose of in control group.It's to say that SMI can adjust the change ofcytokines,confine systemic inflammatory response syndrome,3.Thelevels of CK-MB after resuscitation in SMI are lower than controlgroup after resuscitation.The research states:SMI can protect themyocardial cell membrane,decrease the release of myocardialenzyme.4.SMI using in the PLS phase has obviously therapeuticefficiency for protecting the heart function and circulation state,andmay increase the successful rate of CPR.Above all,SMI can efficiency protect myocardia in ischemiareperfusion.SMI using in the PLS phase may increase the successfulrate of CPR.SMI is worthy of applying in the treatment ofresuscitation.