| Chronic obstructive pulmonary disease (COPD) is a preventable and treatable common disease characterized by persistent airflow limitation. Airflow limitation displays progressive development, accompanied by the increase of airway and lungs chronic inflammation caused by noxious particles or gas. Acute exacerbation and complications affect the severity of patients’ overall disease.With the progress of chronic obstructive pulmonary disease, peripheral airway obstruction, destruction of lung parenchyma and pulmonary vascular abnormalities reduce the exchange capacity lung gas, and result in hypoxemia, and hypercapnia may occur later. Chronic hypoxia can lead to extensive contraction of the pulmonary vascular and pulmonary hypertension (PH), accompanied by intimal hyperplasia frequently, and some vascular fibrosis and occlusion bring about the restructuring of the pulmonary circulation. The pulmonary vascular endothelial growth factor, fibroblast growth factor and endothelin-1(ET-1) may be involved in the restructuring process. To patients with chronic hypoxia-induced pulmonary hypertension, ET-1expression was significantly increased in pulmonary vascular endothelial. The ET-1has a certain effect on pulmonary hypertension appeared in the late period of chronic obstructive pulmonary disease. Pulmonary hypertension of the terminal chronic obstructive pulmonary disease is a serious cardiovascular complication of chronic obstructive pulmonary disease, Chronic pulmonary heart disease and right heart failure thus produced and indicate a poor prognosis. Early and effective control of pulmonary hypertension has an important significance to improve chronic obstructive pulmonary disease complicated by pulmonary hypertension in patients with the quality of life, slow disease progression.PH diagnosis and treatment guidelines jointly issued by the2009European Respiratory Society (ERS) and European Society of Cardiology (ESC) states clearly: chronic obstructive pulmonary disease or interstitial lung disease-related PH has no specific treatment currently and current treatments aim at the primary disease chiefly. The first clinical need is to optimize the conventional treatment of COPD and bronchodilator is the essential medicine for chronic obstructive pulmonary disease complicated by pulmonary hypertension, which aims to improve the airflow limitation and oxygenation. Therefore the best bronchodilator should be chosen in the combination therapy. The existing treatment and commonly used drugs are:smoking cessation, long-range oxygen therapy, inhaled nitric oxide, calcium channel blockers, angiotensin converting enzyme inhibitors, prostacyclin, phosphodiesterase5inhibitors, endothelin by antagonists, statins, lung volume reduction surgery and lung transplantation, gene therapy, etc. But the new guidelines do not recommend the use of traditional vasodilators such as calcium channel blockers, angiotensin-converting enzyme inhibitors for the treatment of chronic obstructive pulmonary disease complicated by pulmonary hypertension, because these drugs can inhibit hypoxic pulmonary vasoconstriction, adverse impact on gas exchange and long-term treatment results are not ideal. New vasodilators (prostacyclin factors, phosphodiesterase5inhibitors, endothelin receptor antagonists) still lack for large-scale randomized controlled studies of chronic obstructive pulmonary disease-related pulmonary hypertension and a small amount of research results were disappointing. The study results of statins in curing chronic obstructive pulmonary disease and its associated pulmonary hypertension are encouraging because of its antioxidant, anti-inflammatory and immunomodulatory effects. Endothelial progenitor cells which have been used for animal pulmonary hypertension attenuates monocrotaline-induced pulmonary hypertension. However stem cells may have a carcinogenic effect, and have little influence upon intimal hyperplasia and pulmonary vascular remodeling. Whether the new drugs for the treatment of PH are effective in "disproportionate" pulmonary hypertension mergering by chronic obstructive lung diseases or not is worthy of further study.The medical treatment for pulmonary hypertension induced by chronic obstructive pulmonary disease is still unsatisfactory and there is no more mature treatment of medicines and practice. How to improve efficacy, delay disease progression, reduce treatment side effects and healthcare costs and how to improve the quality of patients’ life is important issues which need to be solved urgently. Therefore, more and more people target on Chinese medicine.Chronic obstructive pulmonary diseases that mostly belong to "cough","asthmatic","lung inflation" or other areas in Chinese medicine, especially is very similar to the description of the symptoms of lung inflation and the etiology and pathogenesis of elaboration. The clinical manifestations of cough, phlegm, dyspnea, chest expansion, nausea and so on.The pathogenesis of chronic obstructive pulmonary disease is false-essence and real-appearance. False-essence means that the lung, spleen and kidney are all virtual Real-appearance means that the heat caused by wind (cold) and the sputum fold stasis. Lung catches the evil of coldness, with persistent loss of governance, and then phlegm and blood stasis injure the righteousness. Lung, spleen and kidney are all damaged, with virtual guard outside is not steady and the invasion of evils repeated easily, and all these can induce the onset of the disease, the pathological changes is false-essence and real-appearance. Acute exacerbation is real and the stable period is on a virtual. The pathogenesis of chronic obstructive pulmonary disease in the acute exacerbation is sputum (phlegm, phlegm) blocked or phlegm and blood stasis, and often concurrently Qi deficiency or Qi and Yin. With mutual influence between the real and the virtual, phlegm and blood stasis is critical.The phlegm-heat course will injure Qi Yin if it lasts a long time. Qi is the gasification of the weakness of body fluid, and body fluid shall metaplasia, contrarily led to lack of phlegm leaving Yin Jinsheng. The Tanyong Pulmonary is gas machine, the loss of lung toward the Lotus may cause blood stasis. Qi cannot lead blood if it is deficient and weak and also can cause stasis; Bleeding resistance make the body fluid circulate unfluently and then promote phlegm endogenous, and eventually become phlegm and blood stasis resistance. If Tanyong Pulmonary is severe, there is disturbance in the sense, with expression as phlegm, phlegm points, mostly heavy convidence of acute exacerbations. When the disease is in the remission and stability, phlegm harm reduce, but it’s hard to get rid of the left harm. Virtuality mostly express as Qi (Yang) and the loss of Yin, concentrated in the lung, spleen and kidney. Qi (Yang) and Yin loss express as Qi (Yang), and mainly damage lung, spleen and kidney especially, the kidney. Therefore, the main pathogenesis of stable period is the virtuality of Qi (Yang) and QiYinLiangXu, concurrently Phlegm.If the disease is in the acute exacerbation, it often shows common cold attack the lungs, the cold outside, drink, phlegm obstruct the lung, phlegm blocking lung, sputum, God awakened and other evidences. If it is in the stability, it often shows common lung qi deficiency, DLS, lung and kidney qi deficiency, lung and kidney Qi and Yindeficiency, and other evidences. Blood stasis both of COPD pathogenesis links, is also a common chief evidence, often concurrently in other syndromes, such as chief of phlegm blocking lung was phlegm stasis lung of phlegm obstruct the lung compared to phlegm-heat The stasis lung of lung and kidney qi deficiency, compared with lung and kidney Qi Deficiency and Blood Stasis Syndrome. Treatment should comply with "urgent is to treat the symptoms","and treat the symptoms of this principle slowly. The heat of acute exacerbation, Ditan, promoting blood circulation and Xuanfei reducing gas, opens into the legislation, taking into account the Qi and Yin. The stability of Qi (yang), Yin of expectorant promotes blood circulation.Based on Stable Regimens of Chronic Obstructive Pulmonary Disease Treatment Guidelines, control group absorb quantitative inhalation joint preparation (bronchial relaxation agents and glucocorticoids), the salmeterol fluticasone powder inhalation (Seretide)50/500ug (productionenterprise:British GlaxoSmithKline Ltd, approved the text:Registration No H20090241) a suction each time (50ug salmeterol fluticasone propionate500ug) once in the morning and once in the evening. The BuFeiHuoxue Method is used on the basis of Western medicine treatment in the observation group, selecting free fried granules (unified preparation from Jiang Yin Tianjiang Pharmaceutical Co., Ltd.) twice a day for8weeks. Before and after treatment, record traditional Chinese medicine syndrome score, arterial blood gas analysis (PaO2and PaCO2, SO2), pulmonary artery systolic pressure, blood, liver and kidney function (ALT, CRE) and6minutes walking test and other indicators of change,then use statistical software for statistical analysis to reach a conclusion.Objective:Lung-tonifying, blood circulation-promoting and phlegm-resolving method (Nourishing lung and activating blood circulation and resolving phlegm) joints conventional Western medicine treatment of chronic obstructive pulmonary disease complicated by pulmonary hypertension, controlled randomly with western medicine alone, through echocardiography, arterial blood gases,6-minute walk test and other objective indicatorsthe changes to probe into its influence on chronic obstructive pulmonary disease complicated by pulmonary hypertension in patients with pulmonary artery systolic pressure.Method:Select40patients with chronic obstructive pulmonary disease complicated by pulmonary hypertension diagnosis and inclusion criteria, using EXCEL to generate random numbers, selecting of the formula "=RAND ()*1", extracting40numbers randomly from0-1to form a random number table, and group them into observation group and control group in accordance with the sequence of time,20cases each.Results:1. The pulmonary artery systolic pressure of two groups of patients had no significant difference before treatment and the pulmonary artery systolic pressure was significantly lower than the control group after treatment with significant differences, indicating that the TCM treatment can effectively reduce the pulmonary artery systolic pressure of chronic obstructive pulmonary disease in patients with pulmonary hypertension, delaying disease progression.2. After treatment, TCM syndromes integral and TCM Syndrome to improve the total efficiency of two groups of patients were significantly different and TCM syndromes of the observation group improved significantly better than the control group. Description of the TCM treatment can significantly improve the clinical symptoms of chronic obstructive pulmonary disease complicated by pulmonary hypertension.3. After treatment, there was more significant difference between two groups of patients in the6-minute walk test and the observation group was much better than the control group. It is proved that the TCM treatment can significantly improve the quality of life of chronic obstructive pulmonary disease complicated by pulmonary hypertension.4. The safety index such as the blood, liver function, renal function of two groups of patients had no significant differences before and after treatment. It shows that it’s safe to use the madicine without significant adverse reactions and patients are easy to accept.Conclusion:Through research, it is proved that the Bufei Huoxue Method based on the Western medicine treatment which can effectively reduce the pulmonary artery systolic pressure, slowing the occurrence of chronic pulmonary heart disease, and has a certainthe clinical feasibility is used for chronic obstructive pulmonary disease complicated by pulmonary hypertension. It can be seen from the results of this study: Cough, sputum, wheezing, fatigue, abdominal distension, anorexia, lip Violet cyanosis and other symptoms of patients in observation group significantly reduced, while the traditional Chinese medicine syndrome score was significantly improved and traditional Chinese medicine syndrome and TCM syndromes the efficacy of scores were significantly better than the control group, showing the advantages of Chinese medicine as a whole concept. However, due to the short timescale of this topic, coupled with the diagnosis of this disease is not easy, so the number of cases is small and the data does not fully reflect the efficacy of the BuFeiHuoxue Method treatment of chronic obstructive pulmonary disease complicated by pulmonary hypertension with the lack of large multicenter clinical controlled trials. If the clinical trials can be further standardized, I believe that the promotion and application of this method can provide a more powerful objective basis.There is no adverse reactions occured to patients with medication during the study period and safety indicators has no significant difference before and after treatment, so it can be considered the Bufei Huoxue Method (the lungs and blood circulation and resolving method for treatment of chronic obstructive pulmonary disease complicated by pulmonary hypertension) is feasible and safe and has no adverse reactions. Unfortunately, due to time, no follow-up after treatment, we lack for objective evaluation of long-term efficacy. |
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