A Clinical Study Of Oral Chinese Medicine And Enema Of Treatment For Acute Exacerbation Of Chronic Pulmonary Heart Disease

ObjectiveIn acute exacerbation of chronic cor pulmonale patients generally accompanied by abdominal distension, loss of appetite, constipation and other gastrointestinal symptoms as the breakthrough point, through observing the clinical effect of oral Chinese medicine and enema of treatment for acute exacerbations of chronic pulmonary heart disease (CPHD) of turbid phlegm and sthenic-Fu syndrome and its effects on blood gas analysis and blood viscosity index, and combined with the "lung and intestine Tong-zhi" theory to discuss the action mechanism of xuan-fei-tong-fu method in treatment of CPHD, to provide theoretical and clinical basis for "lung and intestine Tong-zhi" in treatment of CHPD, also to explore more effective and more treatment methods of TCM of treatment for CPHD.Methods(1) Overviewing "lung and intestine Tongzhi" theory and introducing the experience of the application of "lung and intestine Tong-zhi", and summarizing the advances of modern medicine on "lung and intestine Tongzhi" theory.(2)52cases of acute exacerbation of CPHD of turbid phlegm and sthenic-Fu syndrome patients were divided into treatment group and control group according to their treatment wishes in this nonrandomized controlled clinical trial. Two groups of conventional treatment of TCM and Western medicine are the same, Different is the treatment group use Xuanbai Chengqi Decoction orally and Dachengqi Decoction add Pericarpium Arecae, Radix Paeoniae Rubra retention enema. Retention enema treatment for3days, Xuanbai Chengqi Decoction oral treatment for7days. To evaluate the mortality, hospitalization days, readmission rate in30days and comprehensive therapeutic effects, main symptoms, the minor symptoms, signs, CAT score in two groups of patients and the safety, and observe the improvement of the blood gas analysis and blood viscosity index (such as platelet count, blood coagulation function, blood rheology improvement etc.).Results(1) The lung and the large intestine through the meridians are closely related, the interaction in the physiological functions and pathological effects, laid the foundation for the "lung and intestine Tongzhi" theory. Zhang Qi old doctor of TCM thinks that the whole to maintain smooth stool to relieve symptoms and improve the prognosis of patients with cor pulmonale has important significance, to advocate lung and intestine Tongzhi. According to modern medicine, lung and intestine in embryonic development, physiology and pathology damage exists the close relationship, to provide a theoretical basis for "lung and intestine Tongzhi". And according to modern pharmacological research shows, purgation treatment has the effect of protecting of intestinal mucosa, inhibiting inflammatory reaction and endotoxin removal effect, and can inhibit the occurrence and development of SIRS/ALI/MODS.(2) Two groups of in-hospital mortality, hospitalization days and30day readmission rate had no significant difference (P>0.05), two cases of death are associated with lung infection, were old men, death causes were heart failure, MODS. Infection is the main cause of patients30day readmissions, accounted total return to hospital patients for83.3%, including lung infection accounted for58.3%.(3) The total effective rate of treatment group was96.15%, control group was88.46%. compared the curative effect there was significant difference between two groups (P<0.05), the treatment group was better than the control group. Two groups of patients after treatment, the main symptoms, secondary symptoms, signs score and CAT score were decreased compared with those before treatment, there was significant difference between pretherapy and post-therapy (P<0.01); there was significant difference between the two groups too (P<0.05), the treatment group was better than the control group.(4) Two groups of patients after treatment, the comparison of PaC02and SaO2of control group, there was no significant difference between pretherapy and post-therapy (P>0.05), the PaC02, PaO2and SaO2of the treatment group were significant difference between pretherapy and post-therapy (P<0.05); two groups of PaC02, PaO2and SaO2between the two groups were significant difference after treatment (P<0.05), the treatment group was better than the control group.(5) Two groups of patients after treatment, blood platelet count in group comparison and comparison between groups showed no significant difference (P>0.05). Two groups of PT, FIB group has significant difference between pretherapy and post-therapy (P<0.05), there were also significant difference between two groups (P<0.05). The APTT of control group was no significant difference between pretherapy and post-therapy (P>0.05), the APTT of treatment group was significant difference between pretherapy and post-therapy (P<0.05), and was also significant difference between two groups (P<0.05).(6) Two groups of patients after treatment, there was significant difference between pretherapy and post-therapy of the two groups about the indexes of blood rheology (P<0.05), except the group of ESR and K value, there was significantly difference between the two groups of each index (P<0.05), the treatment group was better than the control group.(7) No obvious adverse reaction of two groups of patients during treatment, mainly discomfort manifestations were diarrhea, do not need special treatment, before and after the treatment (with the exception of white blood cell count and percentage of neutrophil inflammation index), urine, feces and liver and kidney function had no obvious change.ConclusionXuanbai Chengqi Decoction orally Combined with Dachengqi Decoction retention enema in the treatment of acute exacerbation of CPHD of turbid phlegm and sthenic-Fu syndrome has some advantage to conventional therapy in TCM and Western medicine, the comprehensive curative effect is more remarkable, reflected in the improvement of symptoms and signs, reduce the CAT score, improvement of blood gas analysis (decreased PaC02, Pa02and SaO2increased obviously), coagulation function and hemorheology index and so on, and no obvious adverse reaction. Combined with purgation mechanism preliminarily suggest that the mechanism may be-related to correct hypoxia, hypercapnia, improve blood high agglutination condition, high viscosity state, inhibit inflammatory response, protect intestinal barrier and reduce the absorption of endotoxin and so on.