The Study For The Clinical Character And Syndrome Of TCM Of Aortic Dissecting (AD)

BackgroundAortic dissection is a serious vascular disease that threat to human health, it abrupt onset、rapid progress、dangerous disease and high mortality rate. The natural incidence of Aortic dissection about0.5-3.2/10million population, due to differences in medical environment around and treatment level, the literature Throughout is slightly different, in recent years, with the development of imaging technology, the detection rate of Aortic dissection has increased, its incidence has increased year after year. The mortality of aortic dissection is very high, reported in the literature that the mortality rate of aortic disease in the24hours of the beginning was1%-2%per hour, there were about37%-50%patients die without2days when it was incidence, there were about3%patients died of Sudden death.Identical views on aortic dissection on etiology was close relation with atherosclerosis, high blood pressure, high blood sugar, high blood fat, smoking, and praecox family history of coronary heart disease. Pathogenesis of this disease is still unknown because of its multiple mechanisms.The diagnosis depends on imaging studies. The main means of treatment for aortic dissection nowadays are surgery, interventional and conservative treatment. Since their effects are not very good, comprehensive treatment gets more and more attention by doctors. Traditional Chinese Medicine would be the trend of prevention and treatment on aortic diseases in the future not too far. However, There are not the complete report with the TCM diseases> dialectical type、treatment principles in the point of Traditional Chinese Medicine. Investigate aortic dissection TCM Syndromes, there are very important significance for that Chinese medicine in participate in the prevention and treatment of aortic dissection.ObjectiveBy retrospectively study on the98cases, we investigated the TCM syndrome characteristics of aortic dissection and its risk factors, clinical characteristics in modern medicine, to provide basis for identifying the high risk population and early diagnosing of this disease. We hoped that this study could laid a theoretical foundation for TCM prevention and treatment of aortic dissection.MethodsIn this research, a retrospective study method was used for a collection of98patients who by imaging studies to confirm the diagnosis of aortic dissection. Data of these selected patients were recorded, such as diagnosis type, clinical combining situation, main clinical manifestations and TCM diagnosis type and so on. The data above were recorded by Excel to create a data base, then been statistically analysis with SPSS17.0software and descripted. The measurement data were expressed by mean±standard deviation; inter-group data were compared using the t-test and analysis of variance method; count data were expressed by frequency data; inter-class data were compared using chi-square test. Mortality rates were compared using chi-square test、 Spearman correlation analysis and Logistic regression analysis. Based on these data and analysis, TCM syndrome features, high risk factors, pathogenic characteristics and the relationship between syndrome type of aortic dissection were preliminary studied.Results1. The situation for general:In the98cases, the patients who was combining hypertension were most common, accounted for69.39%, followed by arteriosclerosis (59.18%), smoking history (57.14%), high fat blood syndrome (41.84%) and diabetes (38.78%). The most common clinical performance was pain, accounted for100%, followed by vascular noise, kidney symptoms (uric, and protein urine) and shock; the most common pain area was chest, belly; the feature of pain was intense, sustained baffled and blade-like or tear-like.2. The situation for main complaint:There are85cases (86.73%) who complained of pain,6cases who complained of central nervous system symptoms as syncope or disturbances,3cases who complained of shock,3cases who complained of limb pain or numbness,1cases who complained of recurrent dizziness. 3. The situation for diagnosis and misdiagnosed:There are85cases (86.73%) who Confirmed or suspected for aortic dissection. The first clinic misdiagnoses was13cases (13.27%). Which was misdiagnosed as:6cases for acute coronary syndrome (ACS),3cases for acute abdomen,2cases for acute cerebral vascular accident,1cases for pulmonary embolism and1cases for kidney stones. The treatment time for patients was half a day at least, up to30days, the average was3.45days. The time of confirmed required was2hours at least, up to70hours, the average was14.3hours.4. The situation for manner of diagnosis:Application of CT diagnosis of aortic dissection in the case of the most common, accounting for93.88%of, Diagnosis rate is highest in CTA, MRA, DSA, were100%, followed by CT scan and Color Doppler ultrasound.5. The situation for treatment and prognosis:Conservative treatment is the most common. A total of55cases (56.12%), intervention in31cases (31.63%), surgical treatment of12cases (12.25%of the total). In the school period total death in25cases (25.51%),73cases survived (74.49%). The various indicators and mortality were analyzed; results suggest that gender, age, the chief complaint of pain incidence, treatment time, the time of diagnosis, clinical combination situation and there exists no clear correlation between mortality. The Stanford classification, admission blood pressure and heart rate, cardiac tamponade, syncope or disturbance of consciousness and other central symptoms, treatment and mortality exist correlation.6. The characteristics of syndrome type:The syndromes of aortic dissection, phlegm and blood stasis due to Qi deficiency was the most common, accounted for57.1%, followed by the syndrome of phlegm and blood stasis with (16.3%), followed by Qi-deficiency and blood-stasis syndrome (13.3%), Qi-Yin deficiency syndrome of phlegm and blood stasis (10.2%), damp-heat and blood stasis syndrome (3.1%). Through frequency analysis on the basic pigment, the results showed that blood stasis and phlegm most common, accounted for100%and83.67%, respectively; followed by Qi deficiency (70.41%), Qi-Yin deficiency (10.2%) and damp-heat (3.06%). For each TCM syndrome type group, items, such as gender, age, Blood pressure and heart rate, clinical combining situation, the onset features And mortality, were compared. Results showed that the differences were of no statistics significance (P>0.05).Conclusion 1. There were5types of syndrome in the TCM of aortic dissection, mainly including Qi phlegm stasis, phlegm stasis mutual knot, Qi blood stasis, Qi-Yin deficiency with phlegm stasis mutual knot, and damp-heat stasis resistance, among which Qi phlegm stasis was most common. The main pigments of aortic dissection patients were blood stasis, phlegm, insufficient of Qi and Yin, and damp-heat. The core pathogenesis of aortic dissection was stasis and phlegm; and insufficient of Qi was closely related with this disease.2. For the Stanford classification of aortic dissection, patients of type A was more than that of type B; for the De-Bakey classification, type i was most commonly seen, followed by type iii, while type ii was rarely seen. The most popular diagnosis method for aortic dissection was CT examination, followed by color Doppler ultrasound and MR; The average number of diagnosis method was1.46. The main high risk factors of aortic dissection were hypertension, atherosclerosis, large amounts of smoke, high blood sugar, high blood fat, among which hypertension possessed the most obvious effect. The main (primary) clinical performance of aortic dissection patients were violent and lasting of chest back pain, abdominal pain, blade-like or tear-like. Differences existed in clinical performance of patients of Stanford classification:for pain area, patients of type A’s in the fore chest, chest-back, and chest-lumbar-belly, while patients of type B’s in the belly-lumbar-back; for pain character, patients of type A’s violent pain, blade-like or tear-like, while patients of type B’s gas pain; for other properties, the syndrome of patient of type A’s dissymmetry of upper limbs blood pressure, active pulse flap incomplete close/back-streaming syndrome, pleural effusion and pericardial product liquid, while patients of type B’s dissymmetry of lower limbs blood pressure.3. The mortality rate of aortic dissection in the hospital was25.51%, the main factors that affect the outcome in patients were Stanford type、admission blood pressure、heart rate、cardiac tamponade、central symptoms of syncope or disturbance of consciousness、treatment. The aortic dissection patients receiving conservative treatment is the most common, followed is interventional treatment and surgical treatment.