Protective Effects Of Shenfu Injection On Craniocerebral Operation And Focal Cerebral Ischemia-reperfusion Injury

Background Ischemic cerebrovascular disease often leads to neurologic deficits which seriously influence the quality of life and even threaten the survival of patients. Recently, a number of measures and drugs have been proved to protect neurons from ischemia-reperfusion damage. However, there is no effective therapeutic drug in clinic practice. Shenfu injection, a traditional Chinese medicine, was proved to have protective effects on cerebral ischemia-reperfusion injury in rats. But its mechanism and therapeutic efficacy in clinical patients are still unclear. The present study was designed to disclose the mechanism of neuroprotection induced by Shenfu injection and evaluate the therapeutic efficacy in clinical patients.Experiment 1. Objective: To investigate the effects of Shenfu injection (SF) on the expression of HSP70 and HSP90 after cerebral ischemia-reperfusion in rats. Methods: Thirty male Sprague-Dawley (SD) rats weighing 280~320g were randomized into three groups (n=10 in each group): sham-operated group; MCAO group and SF group . The rats in SF group received intraperitoneal injection of SF 10ml kg-1 at 30 min before 120min MCAO. Thepathological outcome and the expression of HSP70 and HSP90 were evaluated at 24h post reperfusion. Results: The pathological outcome of SF group was better than that of MCAO group. The expression of HSP70, HSP90 was negative in sham-operated group. The expression of HSP70 in SF group was significantly stronger than that of MCAO group at 24h after reperfusion, but the expression of HSP90 in SF group presented no difference to that in MCAO group. Conclusion: Transient focal cerebral ischemia induced the expression of HSP70. Administration of SF before cerebral ischemia could increase the expression of HSP70, but HSP90 protein levels remained constant.Experiment 2. Objective: To investigate the effect of Shenfu injection (SF) on the superoxide dismutase activities (SOD) and malondialdehyde (MDA) levels in patient undergoing craniotomy. Methods: Fourty ASA grade I -II patients undergoing elective craniotomy for supratentorial cerebral tumor removal were included in a randomized study consisting of 2 groups: Patients in group II (SF group, n=20) received SF 50ml diluted with 0.9% NaCl 150ml within 20 minutes after opening the dura. Blood samples were taken from internal jugular venous bulb for measuring SOD activities and MDA levels before infusion (BI), after infusion (AI) and 60 min after infusion (AI60), respectively, and Heart rate (HR), Mean arterial pressure (MAP) were recorded. While patients in group I (control, n=20) received 0.9% NaCl 200 ml at the same time. Results: Compared with BI, MDA levels were significant increased at AI60 (P<0.05), but no significant difference was found between BI and AI in group I (P>0.05). In group II , there was no significant difference in MDA levels among BI, AI and AI60 (P>0.05).Compared with BI, SOD activities significantly increased at AI60 (P<0.05), but no significant difference was found between BI and AI in group II(P>0.05). No significant difference was found among BI, AI, and AI60 in group I (P>0.05). Sixty minutes after infusion, MDA levels in group II were significantly lower (P<0.05), and SOD activities in group II were significantly higher (P<0.05) than that in group I , respectively. Conclusion: Infusion of SF attenuates the formation of free radicals in patients undergoing craniotomy .Experiment 3. Objective: To investigate the effect of Shenfu injection (SF) on the recovery in patient undergoing craniotomy. Methods: Two hundred ASA grade I - II patients undergoing elective craniotomy for cerebral tumor removal were included in a randomized study consisting of 2 groups: Patients in group II (SF group, n=100) received SF 50ml diluted with 0.9% NaCl 150ml within 20 minutes after anesthesia .While group I as control group (control, n=100) received 0.9% NaCl 200 ml at the same time. Awakening time from anesthesia (Awak), time of extubation (Extu), length of stay in neurosurgical intensive care unit (NICU), le...