| Hypertension is one of today’s most common cl inical cardiovascular di sease, causing varying degrees of damage to various body organs. The early damage to the heart shows left ventricular diastolic dysfunction (LVDD), which if not be paid enough attention and given corresponding prevention measures, can lead to further and accelerate damage to the contractile function and result in SHF,or lead to DHF with little ejection fraction damage,but all above have a unfavourable prognosis.pay attention to the damage of hypertension to the left ventricular diastolic dysfunction, can prevent the development of hypertensive left ventricular diastolic dysfunction,and improve the prognosis and quality of life of patients. This subject aims at summarizing the clinical syndrome characteristics of hypertensive left ventricular diastolic dysfunction,and evaluating the therapeutic effectiveness of traditional Chinese medicine (TMC) to hypertensive left ventricular diastolic dysfunction by analysing the result of animal experiment,and provide guidance for clinical dotors.This essay is composed of the following three parts:1. theoretical studyThrough reviewing relevant literature, give the overview of modern medicine and TCM res earch progress of hypertensive left ventricular diastolic dysfunct ion, to provide theoretical basis for clinical diagnosis and treatment.2. Clinical investigation2.1ObjectiveTo summarize the clinical syndrome characteristics by analysing the symptoms, signs and TCM syndrome of patients with hyper tens ive left ventricular diastolic dysfunction,and provide guidance for clinical dotors.2.2Methods150cases of patients with hypertensive left ventricular diastolic dysfunction in Guang’an’men Hospital were involved in this survey. To collect informations of patients by questionnaires,such as the name and age, general situation, main symptoms and signs, cardiac ultrasound and other projects were involved.Using Excel software to establish the database,and SPSS17.0statistical software for data analysis.2.3Results2.3.1General situationA total of150hypertensive patients with hypertensive left ventricular diastol ic dysfunct ion were enrol led. Among them,63are male(42%),87are female (58%). Their age are from22to70, with an average age50.57±12.55years old, and52%withnot typical symptoms of heart failure, while48%were DHF. The courses of hypertension are from6months to35years. According to the survey, whether the typical symptoms of heart failure have appeared has significant difference between different courses of hypertension (x’=48.2, P<0.01) Among all the symptoms occurred, there are ten major symptoms, which in sequence are dizziness (75.33%), headache (72%), palm red (68%), fatigue (60%), dark purple lips (56%), heart palpi tat ions (49.33%), chest t ightness (41.33%), cough(40%), shortness of breath(35.33%), chest pain(34%).According to the distribution ratio from high to low,TCM-syndrometypesin sequence are qi and yin deficiency syndrome (26%), yin deficiency and yang hyperactivity syndrome (24%), phlegm syndrome (22.67%), qi of heart deficiency syndrome(18.67%), yang deficiency of heart and kidney (6%), the other (3cases of fiery flaming,1cases of deficiency of Qi and blood, comprising2.67%of the total). The distribution ratio of left ventricular diastolic dysfunction withnot typical symptoms of heart fai lure(LVDDNTS)and DHF in the first5kinds of TCM syndromes exists significant difference (x2=53.532, P<0.01). The DHF has a higher ratio in qi and yin deficiency syndrome, qi of heart deficiency syndrome and yang deficiency of heart and kidney, whi le LVDDNTS has a higher ratio in yin deficiency and yang hyperactivity syndrome and phlegm syndrome.2.3.2The relationship between blood-stasis and TCM syndromes, diagnosises, symptoms and signs scoresAccording to the investigation,76%patients of left ventricular diastolic dysfunct ion with blood stasis syndrome. Whether with a blood stasis syndrome has no obvious difference between the different TCM Types(only the major five TCM syndromes have been analysed), whi le between LVDDNTS and DHF, the difference is obvious, while65.38%LVDDNTS with a blood stasis syndrome, that is87.5%of DHF.Among different TCM syndrome types, the patients with blood stasis tend to get higer scores of the major-ten signs and symptoms. For example,"palm red"and "dark purple lips" in all of the major five TCM syndrome types,"fatigue"in qi and yin deficiency syndrome and phlegm syndrome,"heart palpi tat ions"in qi of heart deficiency syndrome, and "shortness of breath"in yang deficiency of heart and kidney syndrome, scores higer obviously in patients with blood stasis symptom.In different stages of the left ventricular diastolic dysfunction, the patients with blood stasis also tend to get higer scores. Among the major-ten signs and symptoms, dizziness, palm red and dark purple lips in both LVDDNTS and DHF, fatigue,heart palpi tat ions,chest tightness and shortness of breath in DHF have obviously higer scores in patients with blood stasis symptom.2.4ConelusionsBased on the survey results, the course of hypertension and left ventricular diastolic function damage may have a certain relationship. At the same time, the formation of blood stasis syndrome has the important meaning in the occurrence and development of hypertensive left ventricular diastolic dysfunct ion. So, early detect ion, early treatment, promoting blood circulat ion and removing blood stasis properly would be favourable to prevent its occurrence and development, improve the prognosis of patients.3. Experimental researeh3.1Objective To evaluate the effectiveness of Tianmashuxin in hypertension-theraphy and improve the diastolic function of left ventricular, and the feasibility to remedy hypertensive left ventricular diastolic dysfunction by TCM.3.2Methods80male SHR were randomly divided into large, middle and small dose of Tianmashuxin treat-group, positive-control group and blank group, with16rats in each group, while15WISTAR rats were used as normal control group.They were given different doses of Tianmashuxin extract liquid, losartan potassium tablets suspension and distilled water. Administered once daily and measured blood pressure once every2weeks for18weeks. After18weeks, measured the heart function of rats and BNP of abdominal aorta.Analysis datas by SPSS17.0.3.3Results3.3.1Effect on blood pressure in SHRBefore administration, the blood pressure of SHR in each group was significantly higher than that in control group, while each SHR group were no statistically significant differences.2weeks after administration, the blood pressure in positive-control group, middle and small group, was significantly lower than the blank group. After14weeks, the blood pressure in Tianmashuxin group and posi t ive-control group were all significantly lower than that in model group.3.3.2Effect on the left ventricular diastolic function in SHRLVEDP:18weeks after administration, LVEDP in the other groups were obviously lower than positive-control group-dp/dtmax:18weeks after administration,|-dp/dtmax|in the other groups were obviously higer than positive-control group.3.3Effect on BNP in SHR18weeks after administration, BNP in the other groups were obviously lower than positive-control group.4.ConclusionsThe Chinese medical of Tianmashuxin can lower blood pressure and improve the diastolic function of left ventricular effectively. TCM can be considered as a effective remedy to hypertensive left ventricular diastolic dysfunction. |
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