| Background and objectives:Chronic obstructive pulmonary disease (COPD) as one of the globally recognized chronic diseases, with high incidence rate, high mortality and high disability rate. In the late stage of the disease, patients often complicated by chronic pulmonary heart disease, leading to the heart and lung function decline very fast, brings a heavy burden to patients, families and society. Although the international community has a recognized treatment to cure COPD with pulmonary heart disease, but it cannot effectively improve the disease prognosis. A lot of researches found that standardized mode of chronic disease management to establish was effective to delay the development of disease in patients with COPD combined with chronic pulmonary heart disease, reduce the economic burden, and improve the quality of life. Chinese medicine has great advantages in the management of chronic diseases with pulmonary heart disease of COPD. The purpose of this study is to give full play to the advantage of the view of traditional medicine and cure not ill, using unique health and health care technology of Chinese medicine combined with COPD patients who suffered fheart disease from lung disorders slow disease management intervention and evaluation, in order to help the patient self-management disease knowledge and skills, promote and enhance self-management ability and efficiency of the patients, reduce medical costs, so as to control the medical cost of the whole society, improve the health status of COPD with the lung, improve their quality of life.Method:This research adopts the follow-up study method, In 2012 to December 2015 in guangdong province hospital outpatient treatment and hospitalization of COPD patients with cor pulmonale stabilization merger after treatment to improve experimental study. All the information of the patients who suffer with COPD combined with pulmonary heart disease were collected and enter into the Chronic disease management system. Management for always have been incorporated into slow disease to symptoms of traditional Chinese medicine dialectical, and continue to give corresponding intervention of traditional Chinese medicine (including summer winter disease cure, the doctor of traditional Chinese medicine medicinal food, medicines are, eight period of jin and breathing deep breathing exercises). The regular follow-up to patients was done and the patients were reminded to adhere to the measures of Chinese medicine intervention to improve the compliance. The assessment of a related indicators every 2-3 month was performed. For the new patients enrolled into the group, ask them to accept the one by one health education about COPD with pulmonary heart disease for 30 minutes. It tell the patients the research purpose and specific interventions, Eight period of jin and teach patients breathing practice deep breathing (breathing exercise), giving them a self-made pamphlets about chronic disease management of COPD with pulmonary heart disease, in order to facilitate the long-term through learning. Researchers through telephone, home or outpatient follow-up to understand the new incorporated into the traditional Chinese medicine therapy in patients with conditions once a week.1 month later adjustment for 2 weeks, each patient intervention time for at least 3 months, Monthly assessment of the relevant indicators at the first three months of the average. The latter may be changed to a relevant evaluation of 2-3 months. Patients in intervention 6 months and 12 months,18 months and 24 months,30 months 5 point in time, to relevant clinical index of evaluation, using the patients in group data as a baseline, The changes of the indexes of the patients before and after the intervention were analyzed by the health self evaluation outcome prediction index (such as PRO combined with pulmonary heart disease in traditional Chinese medicine COPD scale、Quality of life of adult patients with chronic obstructive pulmonary disease (QOL), Improved UK MRC index (MMRC), Quality of life evaluation form (CAT)),Timely record each assessment in the process of intervention, and the whole process of intervention in patients with disease exacerbations and compliance of the situation, after the observation will collect all the data entry database, statistics and analyze the related evaluation indicators before and after the patients in the intervention of traditional Chinese medicine. Evaluate the effect of Chinese medicine intervention on the clinical symptoms and quality of life of patients Objectively, and to evaluate the safety and feasibility of the patients.Result:In the process of the intervention, in patients with total of 153 people, after the intervention, fall off cases 34 people, including 14 deaths,20 were lost to follow-up,119 people alive and adhere to the management of traditional Chinese medicine. Of the 119 cases, among them into the slow disease management of traditional Chinese medicine for six months of 101,74 12 months,18 months, 63,24 months 44 people,20,30 months 1 36 months. On the choice of intervention, patients are more prone to internal treatment of traditional Chinese medicine medicinal food, and breathing deep breathing exercises. In the 153 patients, including choosing to winter disease summer treat moxibustion (days) 28 people, accounted for 18.3%; Adhere to the traditional Chinese medicine internal and 130 people, accounting for 85%; Patients with traditional Chinese medicine medicinal food there are 143 people, accounting for 93.5%; Breathe deep breathing practitioners have 140 people, accounting for 91.5%; Eight period of jin 65 exercisers, accounted for 42.5%.For living and adhere to the traditional Chinese medicine after the intervention to observe 119 patients after the intervention of traditional Chinese medicine and related indexes before and after intervention 6 months and 12 months,18 months and 24 months and 30 months as the time periodically index evaluation statistical analysis tip:1.After 6 months after intervention of Chinese medicine, the patients’ CAT、mMRC、PRO、TMS、daily life、social life、depression and anxiety index average compared with before, after the paired t test CAT、PRO、TMS、daily life、depression and anxiety P<0.05, statistically significant; And mMRC、 social life index P>0.05, no statistically significant; Results suggest a six-month intervention for patients with traditional Chinese medicine of TCM symptoms、clinical symptoms、quality of life、daily life、mental anxiety and depression status have improved, and patients’improve in the degree of difficulty in breathing and social living conditions is not obvious.2.After 12 months after intervention of Chinese medicine, the patients’ CAT、PRO、TMS、daily life、social life and anxiety mean all the indexes were decreased compared with before, after matching t test the CAT、PR、anxiety of P<0.05, statistically significant; The TMS、daily and social life P> 0.05, no statistically significant; After the intervention of traditional Chinese medicine mMRC index was increased, the mean value from the previous P>0.05 after inspection, not statistically significant; Data analysis for 12 months of intervention of traditional Chinese medicine of traditional Chinese medicine can effectively improve the patient’s TCM symptos、clinical symptoms、the degree of difficulty in breathing and patients quality of life and mental state anxiety.3. Patients after 18 months of intervention in the management of traditional Chinese medicine, compared with before, the CAT、PRO、TMS、daily life and the anxiety index were decreased, after the paired t test PRO、TMS、 daily life, and anxiety index P<0.05, statistically significant; And the CAT P> 0.05, no statistically significant; mMRC indexes of TCM intervention patients after the mean the same as before the intervention, social life index rise by 0.02 compared with before, after the paired t test P>0.05, no statistically significant; Depression in patients with psychological index rise by 0.19 before the intervention of traditional Chinese medicine, after testing the P< 0.05, with statistical significance. Results suggest after 18 months of intervention of traditional Chinese medicine of traditional Chinese medicine in patients with TCM symptoms, clinical symptonu daily life、 anxiety and the quality of life were improved compared with before, but depression is not obvious improvement.4. Patients after 24 months intervention of traditional Chinese medicine, the CAT、PRO、TMS、daily living and depression index were decreased compared with before, after paired t test CAT、PRO、TMS P<0.05, statistically significant; While the psychology of everyday life and depression index P> 0.05, is not statistically significant. mMR、anxiety in patients with psychological index of average rise compared with before, after testing the P>0.05, is not statistically significant. Results suggest that after 24 months of intervention in the management of traditional Chinese medicine, the patients’clinical symptoms and quality of life improved.5. Patients after the intervention of traditional Chinese medicine 30 months, their CAT、mMRC、PRO、TMS、daily life、social life、 depression and anxiety index averages are decreased compared with before, after the paired t test, the PRO、TMS、 anxiety index P<0.05, statistically significant; And CAT、mMRC、daily life、social life and depression index P>0.05, is not statistically significant. Results suggest that 30 months of intervention of traditional Chinese medicine, patients with anxiety symptoms、quality of life and psychological status are improved.6. The traditional Chinese medicine after the intervention, the patient’s PRO、CAT、 mMRC、 TMS、daily life、and anxiety index were decreased, compared with before, the paired t test P< 0.05, statistically significant; The mean depression scores decreased, compared with before, before scoring average and intervention in social life is equal, after paired t test P> 0.05, no statistically difference, suggests intervention of Chinese medicine to the patient’s symptoms of traditional Chinese medicine, daily life, anxiety and the overall quality of life are improved.7. Through the analysis of variance between groups in patients with tip into groups, intervention, intervention in 12 months,6 months intervention in 18 months and 24 months intervention, intervention 30 months, a total of 6 points, CAT, mMRC, TMS, daily life, social life score no difference (P> 0.05); But there are differences between the psychology of the depression and anxiety index score (P< 0.05). PRO and depression in patients with psychological indicators for the matching between different point is found, patients in the intervention group with 30 months, intervention, intervention and intervention 30th months 6 months to 12 months and intervention 30 months, 18 months intervention, intervention and intervention 30th months and 24 months intervention 30 months PRO index difference was statistically significant (P< 0.05). And patients into groups with intervention, intervention 6 months and 6 months intervention, intervention in 12 months and 18 months intervention, intervention in 18 months and 18 months intervention 30th months and 24 months intervention and psychological intervention in 30 months depression index difference was statistically significant (P< 0.05).Conclusion:This research through the intervention of traditional Chinese medicine analysis of related clinical evaluation index after, showed that Traditional Chinese medicine can significantly improve the clinical symptoms of COPD patients complicated with pulmonary heart disease, improve the overall quality of life, and there were different degrees of improvement in the domains of daily life, social life, depression and anxiety states. So it worth to promote in the clinical practices. |
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