| ObjectiveWith the rapid development of China’s economy,social life style has undergone tremendous changes.At the same time,the country has vigorously promoted the reform of the medical system,the social security system has been continuously improved,and people’s living standards and medical standards have been continuously improved.The life span of the population is generally prolonged,but there are many diseases.In particular,chronic diseases have long been troubled by the middle-aged and elderly people,and their happiness index has declined.With regard to the current epidemiological statistics of diseases in China,the prevalence of cardiovascular diseases has been increasing year by year,and it has become younger.Patients suffer long-term pain and affliction.What’s more serious is the general lack of awareness of rehabilitation among patients.Even if they follow the doctor’s advice,but the unhealthy lifestyle has not improved,and the effects of other comorbidities,etc.They are still repeatedly ill,have multiple hospitalizations,and have an increased risk of cardiovascular end points.The physical,psychological and economic conditions are overwhelmed and the quality of life is greatly reduced.Since the main factors for the formation of pathogenesis of coronary heart disease"virtual deficiency" are qi deficiency,blood stasis,and obstruction,TCM syndromes will also evolve with different recovery periods of coronary heart disease.These differences are affected by external factors.It is more related to the individual’s constitution,and the difference in constitution greatly influences the evolution of the disease,the prognosis of the outcome,and the individual’s different response to treatment measures.Therefore,the present study sought to observe the basic conditions of patients who have been diagnosed with coronary artery disease,repeated and multiple hospitalizations,the control of risk factors,and the actual distribution of syndromes and individual physical constitutions,so as to understand coronary heart disease once again and multiple hospitalizations.The current status of cardiac rehabilitation/secondary prevention and the patterns of TCM syndromes and the distribution and development of individual physical constitution provide a reference for the prevention and rehabilitation of integrated Chinese and Western medicine in patients with coronary and heart disease.MethodThe patients selected in this study were 109 patients with coronary heart disease who were hospitalized at Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2017 to February 2018.There were no gender restrictions.69 patients had undergone PCI.40 patients undergo PCI.All patients were collected through clinical questionnaires and jointly searched for paper medical records.The survey included:basic demographic data,diagnosis and treatment of re-admission(intervention or non-intervention),control of risk factors,and traditional Chinese medicine syndromes.Physical identification and so on.Diagnostic Criteria:Stable Angina According to 2007 Guidelines for the Diagnosis and Treatment of Chronic Stable Angina;Unstable Angina Reference to the 2012 Guide to Diagnosis and Treatment of Unstable Angina;ST Elevation Myocardial Infarction and Non-ST Elevation For high-grade myocardial infarction,refer to 2012 Guidelines for the Diagnosis and Treatment of Non-ST-elevation Myocardial Infarction and 2015 Guidelines for the Diagnosis and Treatment of Acute ST-elevation Myocardial Infarction;Coronary angiography report(history);Rehabilitation staging reference "Definition of Chinese Coronary Heart Disease Rehabilitative/Secondary Prevention:Chinese Expert Consensus" is defined;evaluation criteria for TCM syndrome type after interventional intervention are based on the "Evaluation of TCM Syndrome Diagnostic Criteria for Coronary Heart Disease after Intervention" developed by Hao Ruixi and Chen Keji in 2013;TCM syndrome evaluation criteria refer to the syndrome distribution of the "Guidelines for Clinical Research of New Chinese Medicines" revised in 2002.The physical fitness judgment is based on the"TCM Constitution Classification and Judgmen" standard formally released by the Chinese Society of Chinese Medicine in 2009.Statistical methods First,the database was established and checked by SPSS20.0 statistical software for data analysis.Count data are expressed by frequency,and measurement data are expressed as mean ± standard deviation.Ghi-square test is used for comparison between groups.Result1 Sex,age and number of hospitalizations:Through a clinical questionnaire survey of 109 patients with coronary heart disease and statistical analysis of the later period,hospitalizations were 3.74 ± 2.477 times;the maximum age was 95 years,and the minimum was 41 years.The overall average age was 68.10±11.652 years;there were 66 male patients,accounting for 60.55%,and 43 female patients,accounting for 39.45%.According to whether the stent was implanted,it was divided into PCI group(69 persons)and non-PCI group(40 persons).The number of patients with coronary heart disease who were admitted to hospital again and again was mostly male(P<0.05),but the specific distribution of hospitalization times(2-4 times/5-7 times/8-10 times/11-13 times/14-16 times There was no difference in sex between men and women(P>0.05).Patients with coronary heart disease are more likely to be hospitalized again and repeatedly,especially in the PCI group,but there is no significant difference in the distribution of hospitalization(P>0.05).There was no difference in the age distribution between the number of hospitalizations for CHD patients and the age stratification group(40-49/50-59/60-69/70-79/80-89/90-99).P>0.05).Although the sample was not statistically significant when inferring overall trends(P>0.05),the actual distribution of 109 patients with coronary heart disease showed that the number of hospitalizations was mainly 2-4 and the age was 50-89.Years old,especially among 60-79 years old.2 Incidence of gas and hospitalization:The sample was not representative of the actual situation(P>0.05).However,according to the actual frequency distribution table,the incidence of solar cancer in 109 patients is distributed in 20 solar terms,namely,Lichun,Dahan,Xiaohan,Dashu,Daxue,Jingji,Liqiu,Xiaoman,Bailu,rain,cold dew,light snow,winter solstice,and rainy weather.Frost,early winter,beginning of summer,hillock,summer heat,summer solstice.Focus on the beginning of spring,the big cold,Osamu,snow,mainly in the cold winter.Among them,40 patients in the non-PCI group were re-admitted to Taichung,Xiaohan,and heavy snow,and 69 patients in the PCI group were re-admitted to Lichun,Dahan,and Snow.3 Risk factors management:①Smoking:Among 109 patients,smoking history was 54.Daily cigarette smoking was mostly 1-10(48%),smoking cigarette smoking was mostly 41-50 years(25.93%),daily smoking.There was a positive correlation between the number of cigarettes and smoking age and the number of vessels with coronary lesions(P<0.05),and the correlation was significant(the correlation coefficient was 0.243,0.287).The daily smoking number,smoking age,and number of hospitalizations were not representative.Sex(P>0.05).② Drinking:38 of the 109 patients who had a history of drinking,which accounted for 34.86%.Whether or not alcohol consumption was grouped and compared with the number of hospitalizations and the number of coronary artery lesions were not relevant(P>0.05).·③ Blood pressure:Of the 109 patients with coronary heart disease,92(84.40%)were hypertensive patients,including 8 patients with hypertension of the first grade,25 patients with the hypertension of the second grade,59 patients with the hypertension of the third grade;and the control level of hypertension patients For statistics,the maximum systolic blood pressure was 160 mmHg,the minimum value was 95 mmHg,and the average value was 128.58 mmHg;the maximum diastolic pressure was 110 mmHg,the minimum value was 45 mmHg,and the average value was 75.05 mmHg.In patients with hypertension of grade 3,the number of coronary artery lesions was the largest,and the frequency of hospitalization was high.However,there was no significant correlation between hypertension grading and hospitalization frequency(P>0.05).There was a positive correlation between the classification of hypertension and the monitoring of blood pressure,with a correlation coefficient of 0.309;and there was a statistically significant difference between groups(P<0.01).④ Blood glucose:Of the 109 patients,61 were diabetic(55.96%),and combined with the number of vessels with coronary lesions,the maximum number of cases with diabetes combined with three-vessel disease was 29(26.61%).Whether or not diabetes was associated with hospitalization frequency was not relevant.(P>0.05).However,from the actual situation,the number of patients with diabetes is still more than the number of patients without diabetes.⑤ Blood lipids:Of the 109 patients,92(84.40%)had hyperlipidemia,of whom 45 were genotypes tested,7 were E2/E3(15.56%),and 35 were E3/E3(77.78).%),E3/E4 type 3(6.67%),the majority of E3/E3 type can be seen,there is no obvious tendency of cardiovascular and cerebrovascular diseases.The target conditions of blood lipids were TC 44.95%,TG 51.38%,LDL 57.80%,and HDL 30.28%.⑥ Obesity and diet:Obesity was 42(38.53%).Dietary fruits and vegetables were still less in food composition and different from the distribution of coronary artery lesions(P<0.01).The number of three-vessel lesions was the highest.⑦ Regular exercise:There was no significant difference between the regular exercise habits and the number of coronary lesions(P>0.05)and the number of hospitalizations(P>0.05).However,from the actual situation of 109 patients,patients with severe coronary lesions and high hospitalization frequency had less regular exercise.⑧ Sleep status:Insomnia in the PCI group(32,46.38%);insomnia in the non-PCI group(22,55%).4 Evidence-based medication:There was no difference between the clinical use of patients in the PCI group and the non-PCI group(P>0.05)and the medication was focused on the combination of three drugs or four drugs.The correlation between the medication status and the frequency of hospitalization was significant(P=0.002<0.05),but the specific stratification of hospitalization was compared with that of combination therapy,and there was no difference between groups(P=0.743>0.05).According to the patient’s medication compliance analysis,the phenomena of non-compliance with medications such as missed service(57 persons,52.29%)and unauthorized withdrawal(64 persons,58.71%)were more common,and the degree of drug mastery was low and the degree of education(P<There was correlation between 0.05 and age(P=0.019<0.05),but no correlation with hospitalization frequency(P=0.281,P>0.05).The purpose of the re-hospitalization is mainly based on the question of "whether it is necessary to do examinations when prescribing drugs and prescribing drugs on a monthly basis".5 Family history:Based on family history of cardiovascular disease,family history of combined cerebrovascular disease,family history of combined metabolic disease,and the number of patients with coronary artery disease and hospitalization.The sample can not explain the difference between family history and coronary artery lesions(P>0.05).However,the history of comorbid metabolic diseases was different in the number of different coronary lesions,fP=0.038<0.05.There was a difference between single-vessel disease and three-vessel disease,aP =0.019<0.05.6 Rehospitalization and multiple admissions:① Severity of coronary lesions:Multi-vessel lesions are common,of which 44 are mostly triclinic lesions(40.37%).In view of the number of stents,the maximum number of stents was 34.A total of 10 stents were placed in one of them.In tenns of number of placements,there are at least 1 majority,50,and a maximum of 6.From the results of coronary angiography,there were 4 patients with in-stent restenosis.With respect to stenting reasons,acute myocardial infarction(40.68%)and unstable angina(55.93%)were the main factors.There was no significant difference between the number of coronary lesions and the number of hospitalizations(P=0.4501>0.05).However,from the actual frequency distribution,patients with three-vessel disease were still hospitalized more frequently than those with single or double-vessel disease.②Recurrent cardiovascular events:There were differences in recurrence of cardiovascular events between the PCI group and the non-PCI group(P<0.01).The recurrence of cardiovascular events in the PCI group was mainly angina(73.91%),and the non-PCI group was divided by angina pectoris(35).In addition to the majority,most of the patients showed heart failure(22.5%).Similarly,the main symptoms that led to patient visits were also statistically significant(P<0.01).In the PCI group,chest pain(57.97%)was the main cause.In the non-PCI group,chest pain was mostly(30%),but also symptoms of heart failure such as shortness of breath,asthma(22.5%),and dizziness(15%).This is consistent with the recurrence of cardiovascular events.7 Cardiac Rehabilitation:The rate of awareness and participation in cardiac rehabilitation were low,with 43(39.10%)out of 109 patients having heard of it;29(26.4%)saying they had never heard of it,and 16(14.5%)having participated in it.stop.As far as the form of rehabilitation is concerned,66(60%)want to be in the hospital and receive professional guidance;31(28.2%)want to be in the community.The statistical analysis of the recovery stage and number of hospitalizations in 69 postoperative PCI patients was statistically significant(P<0.01).The frequency of admission to patients with stage Ⅲ PCI after PCI was higher.8 TCM syndrome distribution:There was no difference in hospitalization frequency among the three major syndromes of qi deficiency,blood stasis,and turbidity in the PCI group(P>0.05).The main syndrome was compound syndrome(63 persons,91.30%),among which the number of qi deficiency and blood stasis syndrome was the highest,accounting for 38.10%.There was no difference in the distribution of the three major syndromes of qi deficiency,blood stasis and turbidity during the rehabilitation period(P>0.05).In rehabilitation phaseⅠ,there is still a single syndrome.In rehabilitation phase Ⅲ,the composite syndrome type is dominant.There are still deficient factors in early rehabilitation,such as deficiency of qi and deficiency of yin deficiency.In the later period of rehabilitation,qi deficiency,phlegm and blood stasis factors account for more.In the non-PCI group,there were more single syndromes and complex syndromes.When the frequency of hospitalization is small,that is,the patient is admitted to the hospital for the 2nd to 4th treatment,the single syndrome is mainly associated with cardiac arrest syndrome and Qi deficiency and blood stasis syndrome.Cardiovascular card is also the most common;and simple blood stasis card is not common,and there are clips.9 Physical type distribution:The three top constitutions of coronary heart disease after PCI in 69 patients were qi deficiency(28%,42.03%),blood sputum(13%,18.84%),and phlegm(11).People,15.94%).The top three physiques of 40 non-PCI patients with coronary heart disease were qi deficiency(17,40%),phlegm(10,22.5%),yin deficiency(5,12.5%).In addition,according to the physical fitness criteria,both the body and the body are very common,and almost all tend to have one or two other body types.In terms of the number of hospitalizations,the sample did not have statistical significance when evaluating the overall trend(P>0.05).However,according to the actual frequency distribution table,among the 69 patients in the PCI group,the hospitalization frequency distribution of the three constitution types was:qi deficiency>blood stasis>phlegm.Among the 40 patients in the non-PCI group,the distribution of hospitalization for the three constitution types was:qi deficiency>phlegm and dampness>yin deficiency.Conclusion1 Male patients are more likely to be hospitalized again and repeatedly,and elderly women are more likely to be hospitalized again and multiple times.The onset time of repeated hospitalizations focuses on the cold winter and spring weather.2 Whether or not patients with coronary heart disease were placed stents,the risk factors of self-management were poor;medication adherence was poor;regular follow-up content was single,self-management consciousness was lacking;rehabilitation consciousness was weak;this was related to patient’s age,education level and self-care ability.And so closely related.3 The clinical reality is difficult to achieve with the five major prescriptions for cardiac rehabilitation(drug prescriptions,exercise prescriptions,nutrition prescriptions,psychological prescriptions(including sleep management)and smoking cessation prescriptions)and joint interventions for the management of risk factors.Patients and clinicians will focus on the treatment of the disease and neglect prevention.Moreover,exercise prescriptions,nutrition prescriptions,and psychological prescriptions in the five major prescriptions are difficult to implement,and a comprehensive medical team overall plan is needed to truly realize the psycho-biological-social medical model.The concerted efforts of medical institutions and professional teams,and the cooperation of patients,doctors,and medical institutions,have a long way to go.4 The pathogenesis of patients with coronary heart disease revolves around three aspects of "deafness,delirium,and deficiency".With the different stages of the disease,each has its own focuses.Qi deficiency,blood stasis,and turbidity are the three major evidence elements that can exist alone and sandwich each other.The disease is based on the actual "tan,yu,xu",while the imaginary is consistent throughout,especially in the late "qi deficiency" is very prominent.The syndrome type is mainly based on compound syndromes,and syndromes of phlegm and blood stasis and qi deficiency and blood stasis are more common.Chinese medicine constitution classification also revolves around three types of qi deficiency,blood stasis and phlegm and dampness.The single constitution type is rare,and there are many tendencies of the other constitution types. |
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