The Mechanism Of KaiXin Capsule Preconditioning On Preventing Canine Post-resuscitation Myocardial Dysfunction And The Research Of TCM Syndrome Differentiation After Successful Resuscitation

Post-resuscitation myocardial dysfunction (PRMD) is a new medicine concept(also called cardiovascular post-resuscitation syndrome). After resuscitation, patient' s heart has obvious myocardial dysfunction which manifests as acute diluted left ventricle and decrease of myocardial contraction and ejection function. They can lead to repeated hypotension, frequent Ventricular arrhythmia, recurrent ventricular fibrillation and bad prognosis at last. Now it is considered as main reason of resuscitated patients' death in early stage after success of CPR. In the experimental research we study the mechanism of PRMD and the effects of Kaixin capsule on systemic inflammatory response. In clinical Research, By retrospective analyze of the clinical material, researches of the post-resuscitation patients had been done in these aspects: distribution on the TCM syndrome differentiation, clinical significance of NO, TNF-α, CRP in the serum and their relevance.Experimental research Objective: To study the effect of KaiXin Capsule on Cardiac function and inflammatory response in dogs' cardiac arrest and post-Resuscitation. Methods: 15 hybrid dogs were randomly divided into three groups: pseudo-operation group, model group and KaiXin Capsule group. Capital observing indexes were taken notes at the flowing9 time points: ahead of opening pectoral cavity, the time of post-defibrillation, and the time of 5 min, 15 min, 30 min, 60 min, 90 min, 120 min, 180 min after circulation recovering. At that time of recovering circulation in 180 min, The dogs were killed and their hearts were taken from pectoral cavities. Total RNA of myocardium was extracted. The mRNA expression intensity of objective gene was detected by the way of one-step RT-PCR. And at the same time the protein of nucleus was extracted in order to examined NF- kB activity by electrophoretic mobility shift assy(EMSA). Result: MABP, LVWI, D-P, HR of model group and KaiXin Capsule group temporary rose in 5 min of post-resuscitation, but the tendency of MABP, LVWI, CO, CI, CPP lasted low after 15 min and D-P, HR began descent after 30 min. Compared with model group, KaiXin Capsule group's indexes slowing reduced, moreover CO, CI , CPP of KaiXin Capsule group still kept higher level than those of model group (P<0. 05). WAP, PCWP, TSVR and TPVR of model group and KaiXin Capsule group obviously rose in 5 min of post-resuscitation(P<0. 05), but those of KaiXin Capsule group slowing went up, after 30 min of post-resuscitation still maintaining lower level than those of model group (P<0. 05). Compared with that of KaiXin Capsule group and pseudo-operation group, the blood temperature of model group significantly reduced (P<0.05). The mRNA expression of TNF-a and iNOS in pseudo-operation group and model group was obviously different (P<0. 05), moreover the mRNA expression of TNF-a in KaiXin capsule group was suppressed, comparing with that in model group it was significantly discrepant(P<0. 05). The activity of myocardial NF-kB of model group was significantly higher than that of pseudo-operation group(P<0. 05). Compared with model group, the activity of myocardial NF-kB of KaiXin Capsule group was obviously reduced (p<0.05). Conclusion: the experiment illustrated that left ventricle's myocardial dysfunction was present indeed during 4 min of cardiac arrestand post-resuscitation. After post-resuscitation, there were some blood dynamic disorders for example MABP reducing, PCWP increasing and so on. KaiXin Capsule could improve blood pressure and cardiac output in post-resuscitation, recovery myocardial dysfunction in cardiac arrest and post-resuscitation by degrees. KaiXin Capsule perhaps can block or weak genes induction of immune inflammatory molecule such as TNF-α and i.NOS, relieve lesion of myocardial cell after resuscitation by degrees. KaiXin Capsule prevention and cure cardiac malfuction perhaps through restrained the activity of myocardial NF-kB.Clinical Research Objective: To explore the regularity of distribution on the TCM syndrome differentiation after successful resuscitation. Methods: Serum NO,TNF-a , CRP detection and syndrome di fferenation type of TCM were used to observe 36 pationts after success of CPR, compared with 12 men those in healthy control subjects. Result: Among the patients of post-resuscitation, the ratio of deficiency of both Qi and Yin (DQY) is 36.12%, the percentage of the blood stasis due to stagnancy(BSS) is 27.78%, the percentage of the phlegm-heat blocking orifices(PHBO) is 19. 44%, and the deficiency of both Yin and Yang (DYY)is 16.67%. The level of NO of patients after successful resuscitation is higher than that of normal group. Among the 4 TCM syndrome type groups, there was no significant difference between deficiency of both Qi and Yin (DQY) group and the phlegm-heat blocking orifices (PHBO) group in the level of NO, and there was significant difference among other groups. The sequence of the level of NO is DYY, BSS, PHBO, DQY.The level of TNF-α of patients after successful resuscitation is significantly higher than that of normal group. There was significant difference between 4 TCM syndrome type groups. The sequence of the TNF-α level is PHBO, BSS, DYY, DQY. The change of CRP is just like that of TNF-α . Conclusion: Among the patients of post-resuscitation patients, occurrence of deficiency of...