| ObjectiveAt present,the guidelines for heart failure at domestic and abroad highly recommend the treatment model based on neuroendocrine antagonists.However,the low usage rate and insufficient target dose of neuroendocrine antagonists in the clinical practice,which reduce the clinical benefits of standardized treatment of heart failure.'This study will review and analyze the use of neuroendocrine antagonists in patients with heart failure in Jiangsu Provincial Hospital of Traditional ChineseMedicine in 2017,and evaluate the standardized treatment status of patients with heart failure,trying to prove the promoting effect of Yiwenyang Chinese medicine on the use of neuroendocrine antagonists in patients with heart failure.In addition,a prospective study was designed to observe whether Yiwenyang Decoction can improve the dose tolerance of neuroendocrine antagonists and objectively evaluate the efficacy and safety of treatment,so as to promote the benefit of patients with heart failure from standardized treatment.MethodsThis study adopt retrospective and prospective studies:1 Retrospective studyTo compile information collection table and record the hospitalization data of 327 inpatients with heart failure in Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 1,2017 to December 30,2017.To preliminarily understand the current situation of neuroendocrine antagonists in our hospital,and divide them into control group and treatment group according to whether or not to take yiwenyang traditional chinese medicine.152 cases in control group and 175 cases in treatment group were compared.To retrospectively analyze and compare the gender,age,course of disease,complications,cardiac function classification,hospitalization days,the use rate of neuroendocrine antagonists,blood pressure and heart rate between the two groups,and to explore and summarize the differences in the use of neuroendocrine antagonists between the two groups.2 Prospective studyAll the cases included in this clinical study came to the cardiology department of Jiangsu Provincial Hospital of Traditional Chinese Medicine from March 2018 to March 2019.They belonged to the syndrome of deficiency of "deficiency of Heart qi(yang),phlegm and water resistance",the patients who accord with the diagnosis of chronic systolic heart failure were included in 34 cases and 2 cases were dropped out.A total of 32 cases were included for analysis.Finally,32 cases were analyzed.17 cases in the control group and 15 cases in the treatment group.Following the existing guidelines,the two groups were treated with standardized western medicine,based on patients'individual conditions,regular doses of neuroendocrine antagonists were added.On this basis,The treatment group was treated with Yiwenyang Recipe on the basis of the control group for 6 months.The doses of neuroendocrine antagonists in different time periods(3 months and 6 months after treatment)were observed(in order to unify the doses of various drugs,the current doses of drugs accounted for the largest objective,the percentage of standard dose was assessed).And the scores of TCM symptoms,cardiac parameters,blood pressure and heart rate were recorded before and after treatment.Finally,making statistical analysis.Results1 Retrospective study(1)General data analysis showed:?Gender:197 males and 130 females in 327 patients with heart failure.There were 87 males and 65 fermales in the control group and 110 males and 65 females in the treatment group.There was no significant difference in gender distribution between the two groups(P>0.05).?Age:Heart failure patients aged 28-97 years old,of which 60-89 years accounted for the largest proportion.There was no significant difference in age composition between the two groups(P>0.05).?Underlying diseases and complications:the incidence of coronary heart disease,hypertension and atrial fibrillation was in the top three,62.9%,61.8%and 41%respectively.There was no significant difference in the composition of basic diseases and complications between the two groups(P>0.05).?Distribution of the course of disease:There was no significant difference in the course stratification between the two groups(P>0.05);?Heart function classification:NYHA grade ? was 23(7.0%),NYHA grade ? was 211(64.5%),grade ? was 93(28.4%)and grade ? was the largest.There was no significant difference in cardiac function classification between the two groups(P>0.05).?Hospitalization days:There was no significant difference in hospitalization days between the two groups(P>0.05).(2)The usage of neuroendocrine antagonists:?Beta-receptor blockade:After excluding patients with atrial fibrillation and permanent pacemaker,176 patients were enrolled,80 in the control group and 96 in the treatment group.There was no significant difference in the use rate between the two groups at admission,but the use rate in the treatment group was significantly higher than that in the control group at discharge(P<0.05).There was an upward trend in the treatment group,but there was no significant difference compared with the time of admission(P>0.05).(2)Renin-angiotensin system inhibitors:There was no significant difference in the usage rate between the two groups at admission(P>0.05),but there was no significant difference between the two groups at discharge(P>0.05).The decrease in the treatment group was less than that in the control group,but there was no significant difference(P>0.05).?Aldosterone antagonist:There was no significant difference in the use rate of spironolactone between the two groups at admission and discharge(P>0.05).The use rate of spironolactone between the two groups at discharge was similar to that at admission(P>0.05).?The analysis of standard antiheart failure drugs showed:After excluding patients with atrial fibrillation and permanent pacemaker,176 patients were enrolled,80 in the control group and 96 in the treatment group.There was no significant difference in the rate of combination between the two groups at admission(P>0.05).There was no significant difference between the two groups when discharged from hospital(P>0.05).The decrease in the treatment group was less than that in the control group,but there was no significant difference between the two groups(P>0.05).(3)Analysis of hemodynamic indexes:There was no significant difference in blood pressure and heart rate between the two groups at admission and discharge(P>0.05);compared with the control group,the blood pressure and heart rate of the two groups decreased with the use of neuroendocrine antagonists after admission(P<0.05),but the hemodynamics was stable and had good safety.2 Prospective study(1)Analysis of the dosage of neuroendocrine antagonists in the two groups:?The dosage of renin-angiotensin system inhibitors(ACEI/ARB/ARNI)before and after treatment showed no significant difference between the two groups before treatment(P>0.05);the dosage of the two groups after treatment showed an upward trend compared with that before treatment,and there was a significant difference between the two groups after treatment for 3 months(P<0.01);There was no significant difference between the two groups(P>0.05).there was no significant difference in the dosage between the two groups after treatment for 3 months(P>0.01).After 6 months of treatment,there was a significant difference in the dose between the two groups(P<0.05),and the dose in the treatment group was significantly higher than that in the control group.(2)Comparison of beta-blocking dosage:There was no significant difference between the two groups before treatment(P>0.05).After treatment,the dosage of the two groups showed an upward trend compared with before treatment,and after treatment for 3 months,the difference was significant(P<0.01).There was no significant difference between the two groups after treatment for 3 months(P>0.05);after treatment for 6 months,the dosage of the two groups had significant difference(P<0.05),and the dosage of the treatment group was higher than control group.(2)Contrast the curative effect of TCM symptoms:There was no significant difference in TCM symptom score between the two groups before treatment(P>0.05).The effective rate of TCM group was better than that of control group after 6 months of treatment,and the difference was statistically significant(P<0.05).(3)New York Heart Function Classification:There was no significant difference between the two groups before treatment(P>0.05),and there was no statistical difference between the treatment group and the control group after 6 months of treatment(P>0.05).(4)Comparison of left ventricular ejection fraction:There was no significant difference in ejection fraction between the two groups before and after treatment(P>0.05).After 6 months of treatment,the ejection fraction of the two groups showed an upward trend(P<0.05),and there was a significant difference between the two groups(P<0.05).The traditional Chinese medicine group was higher than the control group.(5)Comparison of left ventricular end-diastolic diameter:There was no significant difference between the two groups before and after treatment(P>0.05);after treatment,the left ventricular end-diastolic diameter of the two groups decreased significantly(P<0.05);after treatment,the decrease of the traditional Chinese medicine group was significantly higher than that of the control group,and there was no significant difference(P>0.05).(6)Safety analysis:Comparing the routine blood and urine,liver and kidney function before and after treatment,in the treatment group,creatinine increased slightly(<20%)in 1 case,but there was no significant increase in dynamic observation,and there was no special discomfort in the patients.In the control group,there were 2 cases whose blood pressure was less than 90/60 mmHg and their conscious symptoms were not obvious.No adverse events occurred in the treatment group.ConclusionOn the basis of standardized treatment of Western medicine,the combination of Yiwenyang Chinese herbal medicine can improve the dose tolerance of neuroendocrine antagonists in patients with heart failure,help to follow the guidelines for regular dosage increment,and promote patients with heart failure to benefit from standardized treat;ment.At the same time,it has significant effect on improving symptoms of traditional Chinese medicine,alleviating clinical symptoms,and improving left ventricular ejection fraction,and has good security. |
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