A clinical observation on Shenmai injection for treatment of myocardial injury in patients after cardiopulmonary resuscitation / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the curative effect of Shenmai injection on patients with myocardial injury after cardiopulmonary resuscitation (CPR) and to explore its possible mechanism.Methods Sixty-two patients with cardiac arrest and respiratory arrest admitted to Qingdao Hiser Hospital from January 2010 to December 2016 were enrolled, they were randomly divided into a conventional therapy control group (30 cases) and a Shenmai treatment group (32 cases) and both groups were also treated by conventional treatment. The patients in the two groups were given basic life support of CPR and its commonly used drugs simultaneously. In Shenmai treatment group, the patients were additionally infused intravenously with 100 mL of Shenmai injection once per day. The therapeutic effect was evaluated after treatment for 7 days. On the day before treatment and 1, 3 and 7 days after treatment, the patient's blood was collected to determine the levels of myocardial injury landmarks, serum creatine kinase isoenzyme (CK-MB), cardiac troponin T (cTnT) and N-terminal B-type natriuretic peptide (NT-proBNP), and the incidences of arrhythmia of ventricular tachycardia, ventricular fibrillation (VF) and atrioventricular block were observed in the two groups; the left ventricular ejection fraction (LVEF), stroke volume (SV) and cardiac output (CO) were measured at bedside by two-dimensional echocardiography for the patients of two groups.Results In conventional therapy control group, the levels of CK-MB, cTnT showed a temporary increase after 1 day of treatment, after 3 days of treatment, CK-MB and cTnT were significantly lower than those before treatment, and reached the lowest levels after 7 days of treatment; the level of NT-proBNP after treatment showed a continuous decrease, the levels of LVEF, SV, CO were persistently increased after treatment; in Shenmai treatment group, the levels of CK-MB, NT-proBNP were decreased continuously after treatment, cTnT was firstly increase and then decrease, and reached to the lowest revels after 7 days of treatment while the levels of LVEF, SV and CO were firstly decreased and then increased gradually, and reached to the highest levels after 7 days of treatment; compared with those of conventional therapy control group, the levels of CK-MB, cTnT, NT-proBNP in Shenmai treatment group were significantly lower after 3 and 7 days of treatment [3 days of treatment CK-MB (U/L)was 51±1 vs. 82±3, cTnT (μg/L) was 2.5±0.3 vs. 3.9±0.2, NT-proBNP (ng/L) was 5 810±103 vs. 15 965±152;7 days of treatment CK-MB (U/L) was 27±2 vs. 56±3, cTnT (μg/L) was 1.2±0.3 vs. 2.9±0.2, NT-proBNP (ng/L) was 2 834±123 vs. 4 832±76], while LVEF, SV and CO were significantly higher than those in conventional therapy control group [3 days of treatment LVEF was 0.47±0.03 vs. 0.45±0.02, SV (mL) was 45±5 vs. 39±4, CO (L/min) was 3.7±0.2 vs. 3.6±0.2; 7 days of treatment LVEF was 0.59±0.02 vs. 0.51±0.03, SV (mL) was 55±4 vs. 45±2, CO (L/min) was 5.3±0.3 vs. 4.6±0.4, all P < 0.05]. After CPR, arrhythmia developed in the patients of two groups, and compared with that before treatment, there was no statistical significant difference in the incidence of arrhythmia after 1 day of treatment in Shenmai treatment group (all P > 0.05); the incidence of arrhythmia was decreased significantly after 3 and 7 days of treatment compared with those before treatment, reached to the lowest level on the 7th day of treatment, and the degree of decrease of incidence of arrhythmia in Shenmai treatment group was more obvious than those of the conventional therapy control group [ventricular tachycardia 9.4% (3/32) vs. 20.0% (6/30), VF 9.4% (3/32) vs. 20.0 % (6/30), atrial ventricular block 18.8% (6/32) vs. 36.7% (11/30), all P < 0.05]. Conclusions Shenmai injection has certain protective effect on injured myocardium in patients undergoing CPR, the mechanism is possibly related to reducing the levels of CK-MB,cTnT, NT-proBNP and further improving the LVEF, SV and CO.