Distribution And Evolution Discipline Of Traditional Chinese Medicine(TCM) Syndromes In Perioperation Of Congenital Heart Disease(CHD)

Study ObjectiveCongenital heart disease(CHD) is a serious disease threatening children health.Surgery is the most important method to treat CHD.TCM has been proved beneficial to patients undergoing congenital heart disease(CHD) surgery.How is the distribution and evolution discipline of TCM syndromes in the perioperation ? No experience has been offered before.As the first TCM hospital conducted CHD surgery in our country,by reviewing the 230 cases undergone CHD surgery,we intend to reveal the distribution and evolution characteristics of TCM syndromes in perioperation of CHD,and the relationship between the TCM syndromes and clinical objective indexes.We also hope to find a efficient way to carry forward research on TCM syndromes.Design1.Design survey table,collect the data about patients' basic information, the manifestation of TCM syndromes and clinical objective indexes on the time as:the day before operation,the first day after operation,the third day after operation,and the seventh day after operation.Establish the database.2.Frequency analysis and Cluster Analysis are used to deal with the data and conclude the main TCM syndrome types in perioperation of CHD,refered to TCM diagnosed standard and expertise.3.Logistic Analysis is used to deal with the data,discuss the relationship of TCM syndromes types and clinical objective indexes.SettingCalifornia Heart Center in Guang Dong Province Hospital of TCM.Patients230 patients who had accepted CHD operation in our center from December,2006 to February,2009,with 121 males(52..6%),109 females(47.4%),age 3.2±1.5 years,weight 14±2.7KG,CHD types include VSD 104(45.2%),ASD 50(21.7 %),TOF 28(12.2%),PS 23(10.0%),others 25(10.9%).The clinical objective indexes include:CI 3.3±1.5(L/min/m2),Pp/Ps 56±0.12,Cardiopulmonary bypass time 72±25min.All patients received operations under the conditions of tracheal intubation anesthesia and cardiopulmonary bypass.After the operations,they were send to ICU,The monitored indexes included ECG,invasive blood pressure,breath,SPO2,CVP,drainage,fluid amount.Patient choosed methods1.iddmission standardAll patients have difinite illness histroy,syndrome,sign of CHD,diagnosed by echocardiogram,ultra-velocity CT or cardiography.Age ranges from 1 month to 15 years.2 Excluding standardUnsuitable for addmission standard;With liver or kidney desfunction,mental disorder,uncapable of accommodation,defective material.Approach1.Choose the TCM information by the way of literature learning and expertise requiry.2.Design survey table,including the general information,illness history and relative risk factors,TCM materials,surveillance index in perioperation.3.Ttrain the surveyors,qualified to survey after passing exams.4.Gather the data about the individual characteristics,operation records, cardiopulmonary bypass,ICU surveillance indexes and differentiation of TCM syndromes.Record the TCM materials on the day before operation,the first day after operation,the third day after operation,the seventh day after operation.Establish the data base about the patients' individual information and TCM information using the statistical software SPSS 13.0 for Windows.Diagnosed methodThe diagnosed standand referred to《Intergrated Chinese and Western medicine for surgery》,《TCN diagnose》,as well as expertise differetiation of TCM syndrome.Statistical methodEstablish the data base about the patients' individual information and TCM information using Epidata 3.0 statistical soft,Frequency analysis and Cluster analysis are used to deal with the data and find the main TCM syndrome types in perioperation of CHD,refered to TCM diagnosed standard and expertise. Logistic Analysis is used to deal with the data,discussing the relationship between TCM syndromes types and clinical objective indexes.Main Results1.Frequency analysis is used to deal with the indexes including all the signs, tough,pulse.Cancel the low frequent indexes,filter and gain the main sign indexes(Z1~Z35),minor sign indexes(C11~C25),tough and pulse indexes (S1~S28),form the frequency distribution table.2.Cluster Analysis is used to deal with the 88 indexes,and under the instruction of famous professors,we conclude the most frequent 7 TCM syndrome types,which can be divided into 2 groups:the simple TCM syndrome group including TCM syndrome Deficiency of Heart-Qi,Lost of Heart-Yang,Lost of Blood,Blood Stasis,Stagnation of Phlegm,the double TCM syndromes group includes TCM syndrome Deficiency of Heart-Qi and Heart -Yin,Deficiency of Qi and Stagnation of Phlegm.Calculate the R2 of each index,which can refrect the contribution degree of each index to the TCM syndrome,and according to R2,we can identify the diagnosing factors for these 7 TCM syndromes.3.Statistical analysis shows that diversity exists in the TCM syndromes at different time of perioperation(the day before operation,the first day after operation,the third day after operation,the seventh day after operation), so do in different CHD types(VSD,ASD,TOF,PS,others).Age and weight are the important correlative factor of the TCM syndromes type Deficiency of Heart- Yang.CI(Cardiac Index) decreases and more syndrome type Deficiency of Heart- Yang occur.Cardiopulmonary bypass cross-clamping time is the important correlative factor of TCM types Deficiency of Heart- Yang and Lost of Blood.Pp/Ps is negative correlative with syndrome type Stagnation of Phlegm.Deficiency of Heart- Yang is the most common TCM type in the complications such as low heart output,pulmonary hypertension,and acute renal failure,the blood coagulation dysfunction is most manifested as the TCM type Lost of Blood;Stagnation of Phlegm is the common TCM type for lung infection.Gasointestinal dysfunction is most manifested as the TCM type Deficiency of Heart-Qi4.Logistic Analysis on the affecting factors of TCM syndrome in the CHD perioperation shows that the correlationship between TCM syndromes and different kinds of CHD(VSD,ASD,TOF,PS,others):ASD is most manifested as the TCM type Deficiency of Heart-Qi,TOF is most manifested as Deficiency of Heart- Yang and Blood Stasis,PS is most manifested as Stagnation of Phlegm,Deficiency of Qi and Stagnation of Phlegm.Correlationship exists between objective index(Age,weight,Cardiopulmonary bypass cross-clamping time,Pp/Ps,CI) and TCM syndromes:Age and weight are negative relative with TCM syndromes type Deficiency of Heart- Yang.CI(Cardiac Index) decreases and more syndrome type Deficiency of Heart- Yang occur.Cardiopulmonary bypass cross-clamping time and Pp/Ps are positive relative with TCM types Deficiency of Heart- Yang,More Cardiopulmonary bypass cross-clamping time will lead to more TCM syndrome Lost of Blood.Pp/Ps is positive relative with syndrome type Deficiency of Heart-Qi and Stagnation of Phlegm.Deficiency of Heart- Yang is the most common TCM type in the complications such as low heart output, pulmonary hypertension,and acute renal failure,the blood coagulation dysfunction is most manifested as the TCM type Lost of Blood;Stagnation of Phlegm is the common TCM type for lung infection.Gasointestinal dysfunction is most manifested as the TCM type Deficiency of Heart-QiConclusionDisciplines exist in the distribution and evolution of TCM syndromes in perioperation of CHD.Objective index can be used to instruct differentiation of TCM syndromes and contribute to reveal the disciplines.The main TCM syndrome types in the perioperation of CHD include Deficiency of Heart-Qi,Lost of Heart-Yang,Lost of Blood,Blood Stasis,Stagnation of Phlegm,the double syndrome group includes TCM syndromes as:Deficiency of Heart-Qi and Heart -Yin,Deficiency of Qi and Stagnation of Phlegm.Diversity exists in the TCM syndromes at different time of perioperation(the day before operation,the first day after operation,the third day after operation,the seventh day after operation).Correlation exists between objective index(Age,weight, Cardiopulmonary bypass cross-clamping time,Pp/Ps,CI) and TCM syndromes. Different TCM syndromes exist in different complications after operation.The TCM syndrome materials can be thoroughly and efficiently analyzed by the way of multiplex statistical method.Objective index can be used to instruct differentiation of TCM syndromes,which can help to realize the objectization, standard and quantitization of TCM syndrome differentiation.