| Purpose:More and more concerns have arisen in the standardized treatment of acute heart failure due to that the emergency mortality of acute heart failure is up to 9.6%.Different degrees of dyspnea,hypoxemia and even respiratory failure are the main clinical manifestations of acute left-sided heart failure.And quickly relieving dyspnea,correcting hypoxemia and even respiratory failure are the important steps and main goals in the treatment of acute left-sided heart failure.When an extensive of bronchial stenosis occurs,pulmonary ventilation is severely restricted,dyspnea and hypoxemia are further aggravated,and the curative effect of oxygen therapy is reduced.However,there have been few studies focusing the emergency treatment of acute left-sided heart failure complicated with bronchospasm,a more severe clinical condition than acute left-sidedheart failure.In order to find a better treatment for improvement of pulmonary ventilation and correction of hypoxemia in treating this critical condition,and consequently to improve treating effect and reduce mortality,the progress in studies of modern Chinese and Western medicine about acute heart failure was reviewed and the mechanism about the occurrence of bronchospasm in acute left-sided heart failure was discussesed in the research,and on the basis of standardized treatment of acute left-sided heart failure,the therapy of Shenfu injection combined with glucocorticoid was proposed for the first time for acute left-sided heart failure complicated with bronchospasm.This research is intended to discuss the acute effect and the preliminary mechanism inference of the new therapy for the treatment of acute left-sided heart failure complicated with bronchospasm.Methods:The research on theclinical efficacy of the new therapy had been carried out using a method of prospective randomized controlled clinical observation.90 patients who met the diagnostic criteria for acute left-sided heart failure complicated with bronchospasm were randomly and equally divided into three groups:the combination therapy group,the hormone therapy group,and the conventional therapy group.Basic treatment of these three groups was the standardized treatment directed by the latest domestic and foreign guidelines for the diagnosis and treatment of acute heart failure.The aminophylline was used to relieve bronchospasm on patients in the conventional therapy group.Instead of aminophylline,glucocorticoid was applied in the hormone therapy group:Inhaled budesonide suspension was used on hemodynamically stable patients only to relieve bronchospasm,while methylprednisolone injection on hemodynamically unstable severe patients and/or patients with respiratory failure in order to access more therapeutic targetssuch as anti-shock effect other than just relieving bronchospasm.Based on the treatment programmes of the hormone therapy,intravenous infusion of Shenfu injection was added in the combined therapy.The patients’TCM syndromes and clinical signs and symptoms were recorded every day,and the clinical efficacy and safety of each group were evaluated after 1 week.SPSS 17.0 statistical software was recruited to analyze data in this research.Results:The research results are summarized as follows.Excluding shedding cases due to death or other causes,a total of 83 cases completed the clinical observation:29 cases in the combined therapy group,25 cases in hormone therapy group,and 29 cases in conventional therapy group,respectively.Due to randomly divided,the patients in age,gender,disease duration,TCM symptoms,and diagnostic marker of heart failure aspects in three groups were balanced before treatment.And data analysis also comfirmed that the difference between three groups were not statistically significant,indicating that the baseline data between the three groups were comparable.Evaluationofclinical efficacywas performed on the seventh day of the course of treatment.And the main results obtained were:①Comparison of total effective rate of treatment of TCM syndromes in three groups:96.6%in the combined therapy group,88.0%in the hormone therapy group,and 75.9%in the conventional therapy group(P=0.022);②Clinicalcurative effect onrelieving bronchospasm:The symptoms and signs of bronchospasm in each group were significantly improved after treatment,and curativeeffect of bronchospasm in three groups were 93.1%in the combined therapy group,84.0%in the hormone therapy group,and 65.5%in the conventional therapy group,respectively(P=0.030);③In reducingthe diagnostic marker of heart failure:the level of NT-proBNP was obviously decreased within all groups after treatment(P<0.01),the glucocorticoids therapy was better than the conventional therapy(P=0.001),the SFI combination therapy was better than the conventional therapy(P<0.001),and the SFI combination therapy was better than the glucocorticoids therapy(P<0.001);④Safety indicators:There were no obvious abnormalities in liver and kidney function tests in participants in this research,and no adverse reactions were observed,too.Conclusion:The finding of the preliminary clinical research have led to the conclusion that when used in treating acute heart failure complicated with bronchospasm Yang Qi collapse syndrome,①the hormone therapy isevidently better than the conventionaltherapy in the total effective rate of treatment,in improving patient’ TCM syndroms and signs of bronchospasm,and in reducing NT-proBNP,while②the combination therapy is better than the hormone therapy,③three therapies were safe during the research.The application of glucocorticoids or Shenfu injection combined with glucocorticoids on the basis of standardized treatment of acute left-sided heart failure may improve the efficacy of acute left heart failure with bronchospasm through better and rapid improvement of pulmonary ventilation.Be safe and effective,thenew therapy has broad application prospects. |
PDF Full Text Request