Analysis Of Traditional Chinese Medicine Syndrome Based On Extracorporeal Circulation And Intervention Of Traditional Chinese Medicine

Although it has been developed over half a century,Cardiopulmonary Bypass(CPB)is still a new phenomenon in traditional Chinese medicine.Previous studies have shown that Qi-deficiency,blood stasis,Yang deficiency,blood deficiency,phlegm turbidity and other manifestations are common in patients after cardiopulmonary bypass.However,there are many links involved in cardiopulmonary bypass surgery,such as the injury of positive qi caused by muscle relaxation and sedation drugs,the blood stasis caused by surgical trauma,and the blood loss caused by surgery.The changes of postoperative qi deficiency,blood stasis and blood deficiency can be attributed to various reasons such as surgery,anesthesia and cardiopulmonary bypass.Previous studies have not been able to distinguish whether the changes of Qi-deficiency,blood-stasis,yang-deficiency,blood-deficiency and phlegm turbidness are caused by cardiopulmonary bypass,surgical trauma or anesthesia.With the development of minimally invasive non-cardiopulmonary bypass surgery such as continuous coronary artery bypass,small incision occlusion,transcranial aortic valve implantation,and the increase of patients who only undergo cardiopulmonary bypass rather than thoracotomy,such as ECMO and left heart assistance,it is inevitable that there will be a mistake if the patients still follow the general TCM pathogenesis of cardiac surgery for syndrome differentiation.Therefore,elucidating the effects of cardiopulmonary bypass(CPB)on human body will be helpful to the perioperative TCM syndrome differentiation treatment of cardiopulmonary bypass(CPB)and non-CPB heart surgery,different CPB modes and different CPB time.Objective1.By comparing the TCM syndromes of Coronary Artery Bypass Grafting(CABG)patients with and without cardiopulmonary bypass,the coronary artery bypass grafting(CABG)pathogenesis was preliminarily investigated by excluding the interference factors such as anesthesia,operation mode and perioperative monitoring during cardiac surgery.2.By comparing the score of blood stasis syndrome in patients with cardiopulmonary bypass and non-cardiopulmonary bypass,and excluding the influence of other confounding factors in cardiac surgery,the quantitative evaluation of blood stasis induced by cardiopulmonary bypass was carried out and the correlation between various factors of cardiopulmonary bypass and blood stasis syndrome was discussed.3.To explore the correlation between different cardiopulmonary bypass factors,such as cardiopulmonary bypass time,myocardial ischemia time,myocardial protection methods,and body temperature,and blood stasis syndrome from Stanford Type A acute aortic dissection.4.The clinical verification and application of the above theories were carried out in the treatment of patients with acute Stanford Type A aortic dissection by supplementing qi and activating blood circulation for removing blood stasis.Methods1.The patients undergoing coronary artery bypass grafting were retrospectively analyzed,and the propensity score matching method was used as an analysis tool to adjust the differences in baseline variables between patients undergoing cardiopulmonary bypass and those undergoing off-cardiopulmonary bypass grafting to make them comparable.Based on the Guidelines for the Diagnosis and Treatment of Common Diseases in the Internal Medicine of Traditional Chinese Medicine issued by the Chinese Association of Traditional Chinese Medicine in 2008,the differences in the types of traditional Chinese medicine syndromes after surgery between the cardiopulmonary bypass group and the non-cardiopulmonary bypass group were compared,and the pathogenesis of traditional Chinese medicine of cardiopulmonary bypass was preliminarily evaluated.2.The patients with coronary artery bypass grafting were retrospectively analyzed,and the propensity score matching method was used as an analysis tool to adjust the differences in baseline variables between patients undergoing cardiopulmonary bypass and those undergoing off-cardiopulmonary bypass,so as to make them comparable.Based on the Diagnostic Criteria for Practical Blood stasis Syndrome issued by the Professional Committee of the Chinese Society of Integrated Traditional and Western Medicine in 2016,the difference in the degree of blood stasis syndrome between patients with extracorporeal circulation and non-extracorporeal circulation in the perioperative period was compared,and the correlation between the factors of extracorporeal circulation and blood stasis syndrome was quantitatively evaluated.3.The quantitative score of blood stasis syndrome in perioperative period of patients with acute aortic dissection was prospectively analyzed,and the correlation between different cardiopulmonary bypass factors,such as cardiopulmonary bypass time.myocardial ischemia time,myocardial protection methods,perfusion methods,prefilling volume,ultrafiltration volume,and degree of cooling was compared.4.To prospectively study the effect of supplementing qi and activating blood circulation for removing blood stasis on patients after acute aortic dissection.Stanford type A dissection patients undergoing cardiopulmonary bypass surgery were randomly divided into treatment group and control group.The treatment group was given Tiopi Huxin prescription,which is beneficial for qi promoting blood circulation and removing blood stasis,plus conventional treatment,while the control group was given placebo plus conventional treatment.The quantitative score of blood stasis syndrome was compared between the two groups in perioperative period.At the same time,the postoperative physical and chemical examinations(blood lactic acid,serum creatinine,blood glucose.ALT.AST.CKMB,CTnI,pro-BNP.procalcitonin,left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left atrial diameter and pulmonary artery pressure)and hemodynamic indexes(vasoactive drug score,mean heart rate and mean motion)were compared between the two groups Pulse pressure,central venous pressure and cardiac output index),complication rate and mortality.Result1.A retrospective analysis was performed on 396 patients with simple coronary artery bypass grafting,and they were divided into CPB group and non-CPB group according to whether they underwent cardiopulmonary bypass or not.Due to the imbalance of baseline features between the two groups,the covariates of baseline features were more balanced after 184 patients were matched using the propensity score matching method.If there is no difference between cardiopulmonary bypass(CPB)and cardiothoracic syndrome in patients with coronary artery bypass surgery,blood stasis and qi stagnation are more common in the early postoperative period,and heart-qi deficiency syndrome is the main one week after surgery.However,the trend of syndrome changes was not consistent between the cardiopulmonary bypass group and the non-cardiopulmonary bypass group.There was no statistical difference in the comparison of general data between CPB group and non-CPB group screened by propensity score matching method(P>0.05),and no significant difference in TCM syndrome types between the two groups before surgery and one week after surgery(P>0.05),but the proportion of cardiovascular blood stasis syndrome and heart-qi deficiency in the CPB group was significantly increased in the early postoperative period(P<0.05).However,Qi-stagnation cardiothoracic syndrome increased significantly in non-CPB group(P<0.05).2.A retrospective analysis was performed on 373 patients with simple coronary artery bypass grafting,and they were divided into CPB group and non-CPB group according to whether they underwent cardiopulmonary bypass or not.Due to the imbalance of baseline features between the two groups,the covariates of baseline features were more balanced after 153 patients were matched using the propensity score matching method.The blood stasis score of CABG patients was significantly increased on the first day after surgery(P<0.05),and had no significant difference between the three days after surgery and the three days before surgery(P>0.05),while the blood stasis score on the seven days after surgery was significantly lower than that before surgery(P<0.05).However,there was no statistical difference in the general data between the CPB group and the non-CPB group screened by propensity score matching(P>0.05),and the postoperative blood stasis syndrome score of the CPB group declined more slowly than that of the non-CPB group(P<0.05).Horizontal comparison between CPB group and non-CPB group showed no statistically significant difference in blood stasis syndrome score between the two groups before surgery(P>0.05),but the blood stasis syndrome score of the CPB group was significantly higher than that of the non-CPB group on the first day.the third day and the first week after surgery(P<0.05).By comparing the detailed scores of blood stasis syndrome between the two groups,it can be seen that on the first day after surgery,The CPB group met major criteria 1(dark purple tongue or ecchymosis or petechiae),major criteria 2(face,lips,gums,eyes,and fingers(toes)),major criteria 4(blood from menstruation(blood stasis in organs,tissues,subcutaneous or serous lumen caused by bleeding),and minor criteria 5(manic or amorous).minor criteria 6(pulse occlusion or dyspepsia).The proportion of pulse or no pulse was significantly higher than that of the non-CPB group(P<0.05).On the third day after surgery.the proportion of CPB group meeting the main criterion 1(dark tongue or ecchymosis or petechiae)and secondary criterion 6(pulse puccination or nodule.or no pulse)was significantly higher than that of non-CPB group(P<0.05).On the 7th day after operation,the proportion of CPB group conforming to major criterion 1(tongue purpleness or with ecchymosis and petechiae),major criterion 3(varicose veins or abnormal capillary dilation at different locations)and minor criterion 6(tongue purpleness or with ecchymosis and petechiae)was significantly higher than that of non-CPB group(P<0.05).Spearman correlation analysis was performed on the factors of CPB group,such as cardiopulmonary bypass time,myocardial ischemia time,myocardial protection method,perfusion method,pre-filling amount,ultrafiltration amount,and cooling degree,and the score of postoperative blood stasis syndrome,and it was found that there was a significant positive correlation between cardiopulmonary bypass time and ascending aorta occlusion time(P<0.05).There was no significant correlation between the other factors of cardiopulmonary bypass and the score of postoperative blood stasis syndrome(P>0.05).3.The quantitative score of perioperative blood stasis syndrome in 118 Stanford type A patients undergoing cardiopulmonary bypass surgery who met the inclusion criteria showed that the blood stasis syndrome score showed a downward trend on the 1st,3rd and 7th day after surgery,and there were significant differences among all groups(P<0.05).Spearman correlation analysis of various factors of cardiopulmonary bypass and postoperative blood stasis syndrome score showed that:Cardiopulmonary bypass(CPB)time,myocardial ischemia time,perfusion crystal amount,defibrillation reactivation.precharge amount and the highest lactate level during CPB were positively correlated with blood stasis scores on day 1.day 3 and day 7 after surgery(P<0.05).Myocardial perfusion was positively correlated with blood stasis syndrome scores on day 1 and day 3 after surgery(the combination of anterograde perfusion and reverse perfusion was more inclined to have higher blood stasis syndrome scores,P<0.05),while the lowest anal temperature and nasopharyngeal temperature were negatively correlated with blood stasis syndrome scores on day 1,day 3 and day 7 after surgery(P<0.05).4.76 Stanford type A patients with acute aortic dissection who underwent cardiopulmonary bypass surgery meeting the inclusion criteria were divided into Tiopi Huxin prescription treatment group and control group.The blood stasis score of Tiaopi Huxin formula treatment group was significantly lower than that of control group on the 1st,3rd and 7th day after surgery(P<0.05).and the postoperative alanine aminotransferase(ALT),the highest postoperative brain natriuretic peptide precursor(pro-BNP)and the postoperative ICU time were significantly lower than those of control group(P<0.05).In addition,Tiaopi Huxin formula has a tendency to improve postoperative hemodynamic indexes(such as vasoactive drug score,mean arterial pressure,cardiac output,etc.),reduce postoperative low cardiac output syndrome,perioperative myocardial infarction,acute renal failure and other complications,and reduce postoperative mechanical ventilation time and mortality within 30 days after surgery.However,due to the small number of cases,it has a tendency to reduce postoperative mechanical ventilation time and mortality within 30 days.No statistical difference was found(P>0.05).Conclusion1.The CPB group and the non-CPB group,screened by the propensity score matching method,had the same general information,operation mode,anesthesia mode and postoperative monitoring and treatment.The proportion of postoperative cardiac blood stasis syndrome and heart-qi deficiency in the CPB group was significantly increased,so factors such as surgical operation,anesthesia and postoperative monitoring could be excluded.It was proved that the pathogenesis of cardiopulmonary bypass in traditional Chinese medicine is a process of deficiency and accumulation,deficiency of heart and qi and stagnation of blood stasis,that is,cardiopulmonary bypass can easily lead to deficiency of Qi and blood stasis.2.The CPB group and the non-CPB group,screened by the tendency score matching method,had the same general information,operation mode,anesthesia mode and postoperative monitoring and treatment,and the blood stasis syndrome score of CPB patients was significantly higher than that of non-CPB patients,so CPB was a single factor causing postoperative stasis.The time of cardiopulmonary bypass and cardiac arrest were positively correlated with postoperative blood stasis.Therefore,the treatment of activating blood circulation and removing blood stasis should run through the whole process after cardiopulmonary bypass heart surgery.The longer the cardiopulmonary bypass time and the longer the cardiac arrest time,the more the treatment of activating blood circulation and removing blood stasis should be strengthened.3.Blood stasis syndrome is common after acute aortic dissection.Studies on cardiopulmonary bypass(CPB)and postoperative blood stasis syndrome score of Stanford Type A aortic dissection show that there is a significant positive correlation between CPB time,ascending aorta occlusion time,perfusion crystal volume,defibrillation reactivation,precharge volume,highest lactate level during CPB and myocardial perfusion mode.The lowest temperature during operation was negatively correlated with the score of blood stasis syndrome.Therefore,according to different cardiopulmonary bypass time and different cardiopulmonary bypass methods,the postoperative treatment of activating blood circulation and removing blood stasis can be provided guidance.4.Prospective studies have confirmed the pathogenesis of traditional Chinese medicine,which is easy to induce Qi-deficiency and blood stasis by cardiopulmonary bypass.Therefore,the treatment of tonifying qi and activating blood circulation for removing blood stasis is helpful to improve blood stasis symptoms,postoperative ICU time and postoperative cardiac and liver function indexes of patients after aortic dissection.At the same time,there was a trend of improving postoperative low cardiac output syndrome,perioperative myocardial infarction,acute renal failure,reducing postoperative mechanical ventilation time and mortality within 30 days after surgery.