Evaluation Of Curative Effect Of Integrated Traditional Chinese And Western Medicine On Pulmonary Function In COPD Based On Real World Study

Objective:Based on the real world study,in the complex real clinical environment to analysis the basic information,medication characteristics in hospitalized patients with COPD.And objective to assessment of real and complex efficacy to improve lung function index of COPD according to the clinical environment of traditional Chinese medicine and Western medicine for future prospective study of real world COPD patients to lay a solid foundation.Methods:In the real world study mode,by retrospective study,the First Affiliated Hospital of Henan University of TCM,Zhengzhou People Hospital HIS database system as the basis,take the full sample design,April of 2017-November of 2017 in November were all diagnosed COPD patients were included in the scope of clinical research,collection of electronic patient data,database.Using frequency description,correlation analysis,cluster analysis,factor analysis,propensity score analysis and other statistical methods,basic information,drug laws and characteristics of COPD in hospitalized patients with pulmonary function,objective assessment of real and complex clinical environment combining traditional Chinese and Western medicine treatment efficacy evaluation of pulmonary function index COPD improvement.Results:This study according to inclusion and exclusion criteria 426 cases from 336cases treated with combination of traditional Chinese and Western Medicine Hospital of traditional Chinese medicine,90 cases from the West hospital routine treatment of Western medicine and other Western medicine diagnosis disease merger of 45 cases,8cases of the syndrome during hospitalization,combined with traditional Chinese and Western Medicine injection,injection,oral medicine,Chinese medicine 155 kinds of Chinese herbal medicine and other drugs,336（including 170 herbs）.The results ofthe study are as follows:1 general informationThe average age of the patients in the study were（66.25±12.37）years old,COPD correlated with age,mainly in the elderly,and the onset of the younger trend,COPD disease in male patients than female patients,female age is earlier than men,women are more likely to occur in the early stage of COPD.The FEV₁ classification of lung function of the patients was mainly severe and severe.2 clinical combined diseasesStudy on the 45 cases of disease,there are 17 kinds of Western medical diseases that are more than 5%of the frequency.,as follows:pulmonary infection（43.43%）and coronary heart disease（33.80%）,hypertension（30.28%）,bronchial asthma（26.76%）and chronic gastritis（17.84%）,chronic bronchitis（15.73%）and emphysema（14.55%）,prostatic hyperplasia（12.21%）,diabetes（10.09%）,bronchiectasis（9.62%）,pulmonary fibrosis（8.92%）,cerebral infarction（8.69%）,arrhythmia（8.45%）,pulmo nary bulla（7.28%）,pneumonia（6.57%）,respiratory failure（6.34%）,pulmonary heart disease（5.63%）.3 Analysis of clinical use of COPD patients in real world3.1 Analysis of the combination of traditional Chinese and Western medicine in the treatment of AECOPDThe treatment of clinical medication in patients with AECOPD single species has67 species,19 species of combination of TCM and Western medicine,the use of high frequency as follows:theophylline,gastric mucosal protective agent,cephalosporins,cough and phlegm medicine,blood circulation,hormone inhalation,quinolones,penic illins,immune regulation,anti-inflammatory,expectorant,atomization medium,antic holinergic drugs（tiotropium bromide）,heat,antipyretic analgesics,hormone inhalatio n,antihypertensive drugs,statins,diuretics,cardiovascular Chinese patent medicine.The frequency of use of antibiotics for the treatment of patients with AECOPD follow ed by combination of traditional Chinese and Western Medicine:cephalosporins（33.04%）,quinolones（29.76%）,penicillins（27.68%）,carbopenems（1.28%）,macroli des（1.28%）,anti fungi（1.28%）,the use of hormone inhalation with non hormone age nts（30.95%）,hormone inhalation（13.69%）.3.2 Analysis of the combination of traditional Chinese and Western medicine in the treatment of COPD stable periodA total of 39 patients with clinical medication of single species,24 kinds of singl e variety,high frequency of use for Doxofylline Injection,thymopeptides needle,pant oprazole needle,salvianolic acid,sulbenicillin sodium,dexamethasone injection,levo floxacin,Compound Methoxyphenamine Capsules etc..The use of antibiotics for the treatment of COPD patients with stable frequency followed by combination of traditio nal Chinese and Western medicine:cephalosporins（41.58%）and penicillins（38.61%）,quinolones（27.72%）and carbapenems（0.99%）,macrolides（3.96%）,to use hormone hormone inhalation（33.66%）.4 Common syndromes4.1 TCM Syndrome Distribution.There are records of TCM syndrome in 336 cases,standard syndrome after 8,according to the frequency,the frequency is as follows:the phlegm heat in the lung（44.05%）,syndrome of turbid phlegm obstructing lung（36.01%）,lung and kidney qi deficiency（16.96%）,lung spleen deficiency syndrome（11.01%）,Qi and Yin two deficiency（9.23%）,phlegm and blood stasis（7.14%）,Qi deficiency and blood stasis syndrome（2.38%）,wind cold attacking the lung syndrome（2.38%）.4.2 Syndrome distributionIn the study,there were 8 syndromes and 3 diseases.The frequency of disease syndrome was high:sputum（87.20%）,heat（44.05%）,Qi deficiency（39.58%）,wet（36.90%）,blood stasis（9.52%）,yin deficiency（9.23%）.The syndrome of the disease is mainly the lung（90.48%）,involving the kidney and spleen.The syndrome combination of two syndromes and three group,the phlegm+heat+lung is the most common.4.3 Comparison of pulmonary function differences between TCM syndrome groupsThere was no significant difference in lung function index（FEV₁/estimated value,FEV₁/FVC）in each group of COPD patients with different syndrome groups（P>0.05）.5 Analysis of common Chinese traditional medicine in COPDCOPD clinical analysis of commonly used Chinese medicine is expectorant,cough relieving,antiasthmatic,nourishing,clearing away heat,relieving exterior drugs,regulating qi,promoting diuresis,promoting blood circulation and removing dampness,and eliminating dampness.Huatanzhike asthma drugs（ephedra,almond,fritillary,aster,coltsfoot,perilla seed,ginkgo,Tinglizi etc.）with the highest frequency in each syndrome had the highest frequency of use.In addition to the antitussive and expectorant antiasthmatic drugs,the TCM syndrome is commonly used as a common medicine:5.1 Phlegm heat obstructing lung syndrome:mulberry,Scutellaria,honeysuckle and Platycodon grandiflorum.5.2 Syndrome of turbid phlegm obstructing lung:pinellia,dried tangerine peel,Poria,Atractylodes,Trichosanthes,Magnolia,coix seed.5.3 Lung and kidney qi deficiency syndrome:Radix Pseudostellariae,Radix Astragali,epimedium,Radix Codonopsis,Radix Ophiopogonis,Radix Glehniae,Nansha ginseng,Fructus Psoraleae,Fructus corni.5.4 Lung and spleen deficiency syndrome:Atractylodes,Codonopsis,astragalus,yam,Adenophora,ophiopogon root,Schisandra chinensis.5.5 Qi and yin deficiency syndrome:Astragalus root,Schisandra chinensis,Radix Codonopsis,Radix Pseudostellariae,Fructus Corni,radix rehmanniae,Radix glehniae.5.6 Cluster analysis of Chinese medicine with phlegm heat and accumulation of lung can be classified into 3 categories,Cluster 1:bitter apricot kernel,Sichuan Bay,ephedra,aster,100,and dragon;cluster 2:mulberry,Scutellaria,Platycodon,licorice;cluster 3:orange peel,Pinellia ternata,Poria,Magnolia.The cluster analysis of traditional Chinese medicine for phlegm obstructing lung syndrome can be classified into 3 categories.Cluster 1:bitter apricot kernel,Sichuan Bay,ephedra,aster,winter flower and white fruit;cluster 2:pericarp,Pinellia ternata,Poria,Atractylodes and purple soda;cluster 3:licorice,Codonopsis Codonopsis,Astragalus.6 In the patients with AECOPD,the difference of FEV₁/predicted value（%）was statistically significant（P<0.05）,and the estimated value of FEV1/（%）of the lung function index（%）in the combination of Chinese and Western medicine group was better than that of the simple western medicine treatment group;the traditional Chinese medicine combined with the western medicine routine treatment to improve the treatment side.The efficacy of the case has advantages in improving symptoms,improving quality of life,improving AECOPD lung function or delaying AECOPD lung function decline.Conclusion:1 combination with traditional Chinese and Western medicine in the treatment of AECOPD,the frequency of antibiotics and bronchodilators,cough relieving,expectorant and antiasthmatic drugs is the highest,which is basically consistent with the recommendation and requirements of clinical guidelines.There is a discrepancy between the use of hormones and the guidelines.2 COPD is the clinical common syndrome of phlegm heat obstructing the lung,phlegm obstructing lung qi deficiency of lung and kidney,lung and spleen qi deficiency,Qi and yin deficiency syndrome,two phlegm and blood stasis syndrome,Qi deficiency and blood stasis,cold Fanfei syndrome.3 COPD commonly used traditional Chinese medicine are expectorant,cough relieving,antiasthmatic,nourishing,clearing away heat,relieving exterior drugs,regulating qi,promoting diuresis,promoting blood circulation and removing dampness,and eliminating dampness.4 In the patients of AECOPD,the difference of FEV₁/predicted value（%）in medium and long term was statistically significant（P<0.05）,and the estimated value of FEV₁/（%）of the lung function index（%）in the combination of Chinese and Western medicine group was better than that of the simple western medicine treatment group;the traditional Chinese medicine combined with the western medicine routine treatment to improve the treatment side.The efficacy of the case has advantages in improving symptoms,improving quality of life,improving AECOPD lung function or delaying AECOPD lung function decline.