| ObjectiveThis topic explores the effects of combined use of proprietary Chinese medicines on immunosuppressive therapy in postoperative immunosuppressive treatment of lung transplant recipients,conducts research from the perspective of clinical rational and safe drug use to provide evidence-based evidence for rational drug use in the clinic.This subject is studied through literature research,cross-sectional research,meta-analysis,and clinical data analysis.A cross-sectional study was performed to understand the current status of proprietary Chinese medicines in lung transplant recipients.Aiming at the Chinese patent medicines that are frequently used after surgery,the literature analyzes and systematic reviews to understand the occurrence of adverse events and the effectiveness and safety of treating major diseases.Through the analysis of the actual blood drug concentration monitoring data and the systematic review of the literature,we understand its effect on the blood drug concentration of immunosuppressive treatment drugs.To provide evidence-based reference for improving the effectiveness and safety of traditional Chinese medicine after lung transplant recipients and further clinical research.MethodsThis study adopts the method as follows:(1)cross-sectional study:collect 201 7.3 20 19.8 in the cases of lung transplantation patients in hospital information,were retrospectively analyzed,age,gender of the patients with immunosuppressive drugs treatment of postoperative proprietary Chinese medicine drug varieties,usage and dosage,etc to make statistical analysis to evaluate the rationality for use case(2)the literature analysis method:Comprehensively search the electronic database for literature analysis and research on the adverse events of Bailemian capsules used in immunosuppressive therapy after lung transplantation.(3)systematic evaluation analysis method:to search the randomized controlled trials on the treatment of major diseases by jan.2020 with Niaoduqing granule Lianhua Qingwen capsule and Lanqin oral liquid,and select those meeting the inclusion criteria according to the inclusion and exclusion criteria.Results1.Proprietary Chinese medicine in the applications of immunosuppressive therapy after lung transplantation cross-sectional analysis results collected 166 cases of postoperative use of proprietary Chinese medicine,a total of 104 patients with lung transplantation,accounted for 62.65%of its proprietary Chinese medicine involves the 25 varieties,used to nourish the agent xie agent under the principle of blood and qi agent agent clearing damp cough and asthma boosting agent heat sedative agent agent and breeze,pharynx agent to use the number in the top three for best to capsule golden flower clear particles and uric poisonous clear particles in terms of drug combination,vanda 104 patients with two and above 2 kinds of proprietary Chinese medicine 34 cases,accounted for 32.69%In terms of rational drug use,the phenomenon of unreasonable drug use of proprietary Chinese medicine is mainly manifested as repeated drug use and overdose drug use.2.Research results of rational medication after lung transplantation:2.1 Results of literature studies on adverse events in Bailemian capsules:There are 42 literature studies on adverse events in Bailemian capsules,3 of which are case reports.The total number of cases in the study was 2061 and the number of adverse events was 222.Bailemian capsules are used to treat insomnia,depression and restless syndrome.The usage and dosage of Bailemian capsules included in the study are within the scope of the instructions.The treatment measures for 1147 patients were Bailemian capsules combined with Western medicine.The number of adverse events occurred in 168 cases(14.64%);Bailemian capsules combined with 71 Chinese patent medicines and 7 cases(9.86%).843 patients were treated with Bailemian capsules alone,with 47 adverse events(5.57%).The adverse events of Bailemian capsule mainly manifested in the damage of digestive system,nervous system,skin and its accessories.2.2 The effectiveness and safety of Chinese patent medicines in the treatment of clinical diseases:2.2.1 Niaoduqing granules for chronic renal failure:A total of 12 studies were included,with a total of 1215 patients,607 in the test group and 608 in the control group.The total effective rate of Niaoduqing granules in the treatment of chronic renal failure was higher than that in the control group,and the difference was statistically significant(RR=1.55,95%CI[1.29,1.87],P<0.00001).Niaoduqing granules can improve Scr(MD=-52.38,95%CI:[-76.12,-28.64],P<0.0001)and BUN(MD=-4.13,95%CI[-5.50,-2.76],P<0.00001).There was no significant difference in Ccr(MD=1.79,95%CI[-1.87,5.46],P=0.34)and adverse reactions(RR=0.73,95%CI[0.32,1.67],P=0.45)2.2.2 Lanqin oral solution for chronic pharyngitis:A total of 496 cases were included in 5 studies,248 in the test group and 248 in the control group.The total effective rate of Lanqin Oral Liquid in the treatment of chronic pharyngitis was higher than that of the control group,and the difference was statistically significant(RR=1.22,95%CI[1.13,1.32],P<0.00001).Lanqin Oral Liquid can significantly shorten the dry throat(MD=-3.96,95%CI[-5.93,-1.99],P<0.0001),pruritus symptoms(MD=-3.73,95%CI[-4.19,-2.56)],P<0.00001).Foreign body sensation(MD=-3.83,95%CI[-4.95,-2.71],P<0.00001)and itching symptoms(MD=-3.33,95%CI[-4.95,-2.07],P<0.00001)improvement time in the treatment of chronic pharyngitis.The difference is statistically significant.There were fewer reports of adverse reactions in the included literature,and the symptoms of reported adverse reactions were mild and could recover on their own3.The effects of Chinese patent medicines used on lung transplant recipients on immunosuppressive drugs:3.1 Analysis of monitoring results of tacrolimus blood concentration after lung transplant recipients:113 patients with lung transplantation were treated with conventional triple immunosuppressive therapy,and a total of 2969 tacrolimus blood concentrations were monitored per person 26.27 cases.The maximum concentration was 37.1ng/mL,the minimum concentration was 0.5 ng/mL,and the average concentration was 9.39±3.94 ng/mL.Among them,the concentration of tacrolimus is 9.03%less 5ng/mL,the concentration of tacrolimus is 53.62%is between 5-10ng/mL,30.45%is between 10-15ng/mL,and 6.87%is greater than 15ng/mL.A total of 2179 patients who were combined with Chinese patent medicine were monitored after operation,with an average concentration value of 9.61±4.02 ng/mL.A total of 790 patients were monitored without combined use of proprietary Chinese medicines,with an average concentration value of 8.79±3.64 ng/mL.A total of 77 patients with combined use of proprietary Chinese medicines after lung transplantation were monitored for a total of 2179 cases,with an average of 28.29 times per person.The average blood concentration of tacrolimus was 9.61±4.02 ng/mL;a total of 36 patients without combined patent medicines after surgery.A total of 790 cases were monitored,with an average of 21.94 cases per person.The average blood concentration of tacrolimus was 8.79±3.64 ng/mL.The analysis results showed that the average blood concentration of tacrolimus in patients with Chinese patent medicine after operation was higher than that in patients without Chinese patent medicine after operation and the difference was statistically significant(P<0.0001).3.2 Meta-analysis of the effect of Wuzhi Capsule on the blood concentration and maintenance dose of tacrolimus in transplant recipients:A total of 221 cases were included in 4 studies,114 in the test group and 107 in the control group.Combined use of Wuzhi capsules for 1 week(SMD=2.22,95%CI[1.42,3.01],P<0.00001),1 month(SMD=0.64,95%CI[0.18,1.11],P=0.007),3 Month(SMD=0.46,95%Cl[0.11,0.81],P=0.009).Compared with the triple immunosuppressive therapy alone,the blood concentration of tacrolimus was significantly higher than that of the control group and the difference was statistically significant.At 6 months(SMD=0.17,95%CI[-0.17,0.52],P=0.32),the blood concentration of tacrolimus showed no significant difference.With the maintenance window,1 month(SMD=-1.72,95%CI[-2.46,-0.97],P<0.00001),3 months(SMD=-1.59,95%CI[-1.93,-1.24)],P<0.00001),6 months(SMD=-2.29,95%CI[-3.07,-1.52],P<0.00001)The maintenance dose of tacrolimus was significantly lower than that of the control group,while the rejection did not increase rate.ConclusionImmunosuppressive therapy after lung transplantation has the phenomenon of the combination of Chinese and western drugs and the use of Chinese patent drugs is more common.The physiological status of lung transplant recipients is generally poor after operation,and due to the use of immunosuppressive agents and anti-infective drugs,antiviral treatment measures are more cautious and limited.In order to avoid the emergence of drug-resistant bacteria,we prefer to use Chinese patent medicine to treat.The renal burden of lung transplant recipients is heavy due to the use of anti-infective drugs and immunosuppressive agents,and most lung transplant recipients will have different degrees of renal insufficiency in the long term after the operation.In addition,gastroesophageal reflux is also one of the serious complications after lung transplantation.Chronic pharyngitis caused by gastroesophageal reflux is very common clinically because gastric acid reflux to the pharynx causes severe damage to the patient's mucosa.Lung transplant recipients may also experience anxiety,insomnia and other mental symptoms due to physiological,psychological and drug factors.At present,in response to the above problems,Chinese patent medicines such as Niaoduqing granules,Jinhua qinggan granules,Lanqin oral liquid and Bailemian capsules are often used for clinical treatment.According to the results of systematic evaluation and analysis on the efficacy and safety of Niaoduqing granule in the treatment of chronic renal failure,the better clinical efficacy of Niaoduqing granule in the treatment of chronic renal failure can significantly improve renal function and the better safety.The results of systematic evaluation and analysis of the effectiveness of Lanqin oral liquid in the treatment of chronic pharyngitis show that it can effectively treat chronic pharyngitis and significantly shorten the improvement time of symptoms such as pharyngitis,dry pharynx,itching and foreign body sensation,which has certain positive significance for clinical treatment.Bailemian capsule contains a variety of active ingredients with sedative effect,so it should be paid attention to avoid the combination of medicine with the same effect.Pharmaceutical care should be given to avoid the occurrence of adverse reactions during clinical useThis investigation found that due to the lack of understanding of the prescription,efficacy and indications of proprietary Chinese medicine,the interaction of traditional Chinese medicine and the compatibility taboo of traditional Chinese medicine,the clinical use of proprietary Chinese medicine in immunosuppressive therapy after lung transplantation was only caused by the irrational use of western medicine for disease differentiation,overdose and repeated use The results of blood concentration analysis of tacrolimus in lung transplant recipients showed that the blood concentration of tacrolimus in patients with combined use of proprietary Chinese medicine after surgery was different from that in patients without combined use of proprietary Chinese medicine,and the difference was statistically significant.Therefore,the blood concentration of tacrolimus should be closely monitored to avoid toxic reactions in patients with lung transplantation when combined with proprietary Chinese medicine.In addition to maintaining the effective concentration range of tacrolimus after organ transplantation,the combined administration of Wuzhi capsule can reduce the tacrolimus maintenance dose without increasing the risk of acute rejection.Reducing the dosage of tacrolimus can not only reduce the occurrence of toxic reaction,but also reduce the economic burden of patients to some extent At present,there are few clinical studies on the effect of combined use of Wuzhi capsules on blood concentration of tacrolimus after lung transplantation,and the effect of Wuzhi capsules on tacrolimus has individual differences.Therefore,the blood concentration of tacrolimus should be carefully and closely monitored when used in clinical combination. |
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