| Acute myocardial infarction (AMI) is defined as the necrosis of partial myocardial cells when the blood supply of the coronary embranchment is intermitted. Recent researches has testified that there are plenty of oxygen-free radicals produced when the patients meet with ischemia and anoxia. The OFR triggers the lipid peroxidation reaction which cause to the serious complications induced by the severe injury of the myocardia. There are some factors to decrease the clinical mortality as to reinforce the protective effect to the ischemic myocardia and reduce the morbidity of the complications of AMI. So we choose ShengMai parenteral solution to treat the AMI patients who can't accept the thrombolysis treatment. We observed the influence of ShengMai parenteral solution on oxygen-free radicals to explore the curative effect and the mechanism of ShengMai parenteral solution in the conservative treatment of AMI. Our results make the theoretic basis to find the new way curing the AMI patients.Objective: We discusses the function of ShengMai parenteral solution on influencing the OFR level and the protective effect on ischemic myocardia through observing the dynamic changes of the SOD and MDA levels of the patients' serum and the relevant indexes. At the same time we contrast it with the routine treatment group to find out its applicative value on the treatment of AMI patients.Method: All the AMI cases enrolled are in hospital at the intensified care unit (ICU) of the second hospital, Jinlin university, which are not suitable or unqualificated to accept venal thrombolysistreatment. Total number is 48, including man 32, women 16. The ages range at 44-86, and the average age is 66.84+16.42. All the case accord with the diagnostic criterion of WHO. We make the patients into two groups randomly, as the ShengMai treatment group (26 case) and the routine treatment group (22 case); The general datas of the two groups have no significant difference such as the sex> age> the time from falling ill to treating> the necrosis part and the risk factors. So the two groups can make the comparative research. And we choose the 24 persons whose physical examinations are normal as the healthy comparison group. The ShengMai parenteral solution is produced by the Yaan Sanjiu drug company. We put 60ml ShengMai parenteral solution into 250ml solution which can be 5% glucose or 0.9% normal saline. The patients accept this treatment as one time per day, and it can be taken for 14 days long. All the drugs of coronary dilating therapy and anticoagulant therapy are the same with the routine treatment group. The routine therapy uses glucose-insulin-potassium (GIK) and glyceryl trinitrate lOmg into 250ml solution which can be 5% glucose or 0.9% normal saline. The patients accept this treatment as one time per day. Another routine therapy can use low molecular weight heparin 5000u, twice per day, subcutaneous injection. The two treatment groups are taken blood 3 ml in the moring at the in-hospital time, 1st, 3rd, 5th, 7th days after treatment. The healthy comparison group only takes blood 3ml at one time. We make all the blood sample centrifuge 10 minutes at 2000 rotate per minute, and conserve the serum in -20 degree refrigeratory to test.Assay AMI patient blood serum concentration of SOD and MDA with the method of Xanthine oxidasev Colorimetry and thiobarbituric acid chemistry. The stoichiometric parameters of normal distribution are described with x + s; The probability of enumeration data comparing uses x 2 test; The group comparing uses variance analysis and t test. (P<0.05 significant difference. P<0.01 plaguily significant difference).Result: 1 -? The changes of SOD :the serum concentration level of SOD in treatment groups(before treatment), ShengMai treatment group (the lth,3rd,5th day after treatment), routine treatment group(after treatment) are lower than healthy comparison group(P<0.01).There is no significant difference between ShengMai treatment group (the 7th day after treatment) and healthy comparison group( P>0.05). The level of SOD in ShengMai treatment group(the 5th,7th day after treatment)and routine treatment group (the 7th day after treatment) are higher than treatment groups(before treatment)(P<0.01).There is no significant difference between the two treatment groups before treatment P>0.05). At the S^*^ day after treatment, the levels of SOD in ShengMai treatment group are higher than routine treatment group (PO.01). 2^ The changes of MDA .the serum concentration levels of MDA in the two treatment groups(before treatment), ShengMai treatment group(the lth,3th,5th day after treatment), routine treatment group (after treatment) are higher than healthy comparison group (P<0.01).There is no significant difference between ShengMai treatment group(the 7th day after treatment)and healthy comparisongroup( P>0.05). The levels of MDA in ShengMai treatment group (the 5th,7th day after treatment)and routine treatment group (the 7th day after treatment) are lower than the two treatment groups(before treatment)(P<0.01).There is no significant difference between the two treatment groups before treatment( P>0.05). Each time after treatment the levels of MDA in ShengMai treatment group are lower than routine treatment group (P<0.01).3> The changes of CK-MB: Comparing two group's recovering time of serum CK-MB concentration to normal level, ShengMai treatment group are shorter than routine treatment group (P<0.01). 4. The changes of Ca2+: Ca2+ concentrations of ShengMai treatment group after 3rd day treatment are obviously decreased than ShengMai treatment group before treatment (P<0.01), but its changes are all in the normal range. Ca2+ concentrations of routine treatment group after 3rd day treatment are obviously decreased than routine treatment group before treatment(P<0.01), and its changes have lowered than the normal range .5^ complications. Comparing two group's complications morbidity in a week, ShengMai treatment group are significantly reduced than routine treatment group, the morbidity of heart failure has significant difference (PO.05).Discussion: The researches indicate that the decrease of SOD level and the increase of MDA level in AMI patients' serum reflect the increase activity of OFR and the decrease activity of anti-oxidant system. And the results are accorded with the domestic and foreign reports126'301. Such result make it clear that OFR activation is one of the mechanism of the ischemic injury in AMI. In the routine treatmentgroup: SOD activity decreased and MDA increased before treatment, however after treatment, SOD activity reduced at the beginning and then hoisted, MDA activity first hoisted and then reduced, it states that before treatments the activity of OFR have increased and consumed plenty of SOD, so the activity of SOD increased and the MDA activity increased even more after treatments, this maybe due to that the use of glonoin make coronary artery dilatate, then coronary embranchment blood supply increased. At the same time, plenty of oxygen flowing into cells is related with the increase of OFR. This research also tell us that the first day after treatment, SOD decreased to the lowest level, then increased a little, while MDA increased to the peak, then decreased slowly, which is similar to the foreign researchest3638^ may related with that the release of the necrosis things, the changes of the membrane of the ischemia area and the myocardial ischemic reperfusion injury. After treatments, SOD activity decreases farther and MDA increases obviously in AMI patients, these indicate myocardial injury aggravates, and the occurrence of spontaneous reperfusion arrhythmia is one of the causes triggering sudden death. When acute myocardial infarction occurs, myocardial tissues produce plenty of OFR which injuries cells' membrane, then these result in that the change of membranes' integrality and permeability and the dysfunction of membranes' channel and ion pump. Both the reaction lead to ischemic myocardia evolving from reversible injury to inreversible necrosis, consequently leading to severe ventrivular arrhythmia and heart failure[39lThe research also indicates that time ofCK-MB recovering to normal level in the routine treatment is longer than the ShengMai parenteral solution treatment, the incidence of heart failure increased obviously. All above prove that ShengMai parenteral solution can effectively protect the activity of SOD, and reduce the serum level of MDA.It also can reduce myocardial necrosis, obviously restrain the release of myocardial enzyme and reduce the infarction area. The Ca2+ concentration in routine treatment group decreased obviously however decreased relaxedly in the ShengMai parenteral solution treatment and held in normal range. These perhaps are related that ShengMai can eliminate OFR and enhance myocardial anti-oxidant ability. It also can keep the integrality of myocardia, so avoid or alleviate Ca2+ over loading. All above indicate that routine treatments combined with ShengMai injiection can save plenty of dying myocardia so as to protect myocardia from severely injuring.The research states: Before treatments with ShengMai injecition, SOD activity decreased and MDA increased. After the first day with ShengMai treatment, SOD activity reduced obviously then hoisted gradually (P<0.01), while MDA activity hoisted obviously then reduced gradually (P<0.01). It shows that ShengMai can restrain the produce of oxygen free radicals and inhabit lipid peroxidation reaction. Experiment in cellular level demonstrate that ShengMai parenteral solution can improve myocardial mitochondrial respiratory chain function, improve the abnormal approach of electron delivery, so reduce the produce of the oxygen free radicals ; simultaneity increase the activity of intracellular SOD> GSH-PX ,and enhance myocardialcell to clean oxygen free radicals out, decrease MDA concentration110J. The research make it known that compared with with routine treatment group , the activity of SOD and MDA between the two groups had no significant difference before treatment, oppositely after the first day with ShengMai treatment ,SOD activity reduced first and then hoisted, while MDA activity firstly hoisted then reduced; Though the change trend of SOD and MDA in the routine treatment group consists with the ShengMai treatment group, their serum levels have significant difference. The experiment also demonstrates that the morbidity of complication after one week's treatment in ShengMai treatment group is significantly lower than that in the routine treatment group, especially heart failure(heart function III- IV) is more obviously, the difference is significant (PO.05). It can improve myocardial energy metabolizability, protect myocardial ischemia, salvage dying myocardia, reduce infarction area, increase cardiac output, have the effect of intensify cardiac contract, arise blood pressure and anti-arrhythmia by clearing out oxygen free radicals and restraining Ca2+ from over loading,.Conclusion: The researches tell us the decrease of SOD level and the increase of MDA level in AMI patients' serum reflect the increase activity of oxygen free radicals and the decrease activity of anti-oxidant system. It's one of mechanism of myocardial ischemia reperfusion injury in AMI. Compared with routine treatment group , SOD level in ShengMai parenteral solution treatment group significantly increased and MDA level decreased; It significantlyshortens the recovery time of serum CK-MB, decreases the concentration of Ca2+ in serum slowly, and reduces the complication morbidity obviously. All above prove that ShengMai parenteral solution can effectively eliminate oxygen-free radicals and inhabit lipid peroxidation reaction, and have a protective effect on ischemic myocardia.The enhancement of oxygen-free radicals activity may be related with the release of myocardia necrosis, the change of the membranes' integrality and permeability of the ischemia area and the myocardial ischemic reperfiision injury, and all above change consistently. So we should use ShengMai parenteral solution earlier, give interferenced treatment, so as to decrease or eliminate the produce of oxygen-free radical.
|
PDF Full Text Request