Investigation On Cardiac Rehabilitation / Secondary Prevention Status And TCM Syndromes After PCI

Objective:In recent years, the prevalence of coronary heart disease increased year by year, it has become a major killer of threat to the health of our people. Although percutaneous coronary intervention (PCI) can complete revascularization, improve myocardial blood supply, but patients due to lack of awareness of rehabilitation, smoking, drinking, lack of exercise, mental stress, irregular medication and high blood pressure and other adverse factors, risk factors for diabetes, dyslipidemia can not be improved, eventually it will make the difficult postoperative cardiac rehabilitation/secondary prevention of increased,quality of life will be affected. Since qi deficiency, blood stasis, Phlegm three mutual influence of the TCM syndrome after PCI,It is the main factor in the formation of the vacuity, while the TCM syndrome will vary with the rehabilitation period and change. Therefore, this study attempts to observe the situation under control TCM syndrome distribution and quality of life in this part of the risk factors of the patient, to understand the changes and developments in the law of PCI in patients with cardiac rehabilitation status and type of TCM, for the group of patients after PCI rehabilitation Medicine provide a theoretical basis.Method:In this study, patients were from January 2015 to December 2015 at the Beijing University of Chinese Medicine Dongzhimen Hospital outpatient, inpatient treatment of patients with coronary heart stents total of 133 cases, unlimited sex. Rehabilitation of patients with stage I 27 people, the rehabilitation of patients Ⅱ of 18 people, the rehabilitation of patients with stage III 88 people, more patients were collected data through clinical questionnaires. The survey mainly include:basic demographic information, diagnosis and treatment history, after the intervention of TCM Syndrome Diagnosis, TCM symptoms, risk factors, evidence-based drug use, quality of life surveys. Diagnostic criteria:unstable angina and non-ST segment elevation myocardial infarction reference 2012 medical society of cardiology branch to develop a "non-ST segment elevation acute coronary syndrome diagnosis and treatment guidelines," acute ST-segment elevation myocardial infarction reference 2015 "acute ST segment elevation myocardial infarction diagnosis and treatment guidelines"; intervention after syndrome assessment standard reference 2013 Xi Rui Xi, Chen Ji, who developed the "intervention after coronary heart syndrome diagnosis criteria evaluation "; clinical symptoms of angina pectoris assessment standard reference" Chinese Drug "guidelines for angina symptoms and signs quantization tables quantitative score. Statistical methods to establish a database before, after verification using SPSS22.0 statistical software for data analysis. Count data by frequency that the measurement data through the mean ± standard deviation (x±s) represented by 2 comparison test between the two groups.Result:1.Gender, age and disease characteristics:In this study of patients after PCI survey, UA63 (47%), AMI55 (41%), stable angina and 19 (14%), old myocardial infarction 5 (4%). The chances of men suffering from AMI was significantly higher than females (P<0.05). Worsening angina pectoris stenting chance than patients onset of angina (P<0.05); mainly in the age between 50-79 years,50-69 years of age in males than in females (P< 0.05), whereas the incidence in women over the age of 70 than men (P> 0.05).2.Coronary artery stenting with the case:in 133 patients, three lesions in 56 (42%), double vessel disease in 40 (30%), single vessel disease and 19 (14%). Men appear multivessel disease was significantly more than women (P<0.05), more women than men in a single-vessel disease; bare metal stent application rate is too low, the blind pursuit of drug-eluting stents. And according to the results of the analysis of coronary angiography,40 patients who meet indications for CABG, the inappropriate use of stents up to 30%.3. Mission and rehabilitation referral cases:In 133 patients, I rehabilitation of 27 people, Ⅱ rehabilitation of 18 people, Ⅲ rehabilitation of 88 people. Its content awareness for cardiac rehabilitation only 10% of patients overall rehabilitation of consciousness, more single clinician education content; PCI after the referral rate of 60%, and correlated with the education level (P<0.05), which highest undergraduate law referral rate of 91%, only 18% of primary school.4.The control of risk factors:①Smoking:133 patients,74 had a history of smoking, smoking cessation,44, quit rates of 59%, smoking 20 or more patients with three-vessel disease had a higher incidence (P<0.05); ② Drinking:drinking history 53 people, mainly in high spirits-based (55%),17 alcohol, drinking rate of 32%;③ Blood pressure:blood pressure 104, the prevalence rate of 78%, the standard blood pressure were 82 people compliance rate of 62%. Blood pressure, diabetes more difficult to control than non-diabetic patients (P<0.05);④ Lipids:compliance rate of each lipid levels in descending order of TG (62%), LDL-C (49%), HDL-C (47%), non-HDL-C (36%), TC (15%), smoking can significantly reduce levels of HDL-C (P<0.05). ⑤ Blood sugar:the average fasting blood glucose 6.4±1.91mmol/L, the overall compliance rate of 55.64%.43 people with type 2 diabetes, fasting blood glucose average 7.85±.59mmol/L,18.6% compliance rate.⑥ Obesity:In this study, patients with obesity or overweight based, overweight accounted for 80% of the average weight of 71.9±0.25kg, BMI25.88±3.04kg/m2.5.Evidence-based medicine:Forgot medication and age correlated (P<0.05), mainly in 50-59,60-69 years. Drug Application rates were statins (92%), ASP (89%), BB (76%), ACEI/ ARB (56%) 4 coadministered with 42% three drugs combined with 33%. ASP usage of three-vessel disease patients was significantly higher than single, double vessel disease (P <0.05); BB and ACEI/ARB applications, more men than women (P<0.05); Lipitor can significantly improve TG non-HDL-C levels (P<0.05); patients with diabetes or hypertension for ACEI/ARB usage significantly higher than those without complications (P<0.01).6.Quality of life factors:① Age, Gender:In this study,133 patients after PCI average score of 66.77±7.97, coronary heart disease often die score close to the Liujiang Sheng et al measured (63.46±1.4), men scored significantly higher than females (P<0.01), score decreases with increasing age. UA patients’ quality of life will be significantly decreased (P 0.05). ②Exercise:Rehabilitation exercise can significantly improve the quality of life of patients after surgery (P<0.01), but the main form of exercise in patients with a walk, showing blindness, aimless characteristics, have not been targeted after cardiopulmonary exercise testing of rehabilitation.③ Angina:angina exist after 72 people (54%), quality of life was significantly lower than those without angina (P<0.05)④Awareness:a better understanding of the disease can significantly improve the quality of life (P<0.01), but It has nothing to do with education level (P> 0.05).⑤ Insomnia:Insomnia can significantly reduce the quality of life of patients (P<0.05), the probability of female insomnia significantly higher than males (P<0.05).⑥ Anxiety:54% of patients there is a fear and anxiety in the postoperative quality of life was significantly lower than patients without mood disorders (P<0.05). Ⅲ number of anxiety than others (P<0.05), I of the number of patients with a minimum of anxiety. Anxiety problems are mainly concentrated in the "fear of reinfarction," "chest pain after surgery remains," "stent-related lack of knowledge", "after repeated failure and fatigue," and so on, which explains why anxiety is mainly due to surgery inherent limitations and missionary efforts clinician inadequacy.7.TCM syndromes distribution after PCI:133 patients with blood stasis presence of 117 (88%), Qi and 81 (61%), phlegm 83 people (62%), the presence of phlegm patients are more prone to UA (P<0.05); rehabilitation staging, Ⅰ period:Stasis> phlegm> qi deficiency; Ⅱ、Ⅲ period:Stasis> qi deficiency> phlegm, qi deficiency patients in Ⅲ period significantly more than I, II stage (P< 0.05). On syndromes classified as descending, phlegm and blood stasis syndrome 54 (41%), qi phlegm and blood stasis syndrome 22 (16%), blood stasis 21 (16%), ASDP 20 (15%), qi deficiency 8 (6%), phlegm 8 (6%). Phlegm and blood stasis syndrome in each period were higher than the number of other syndromes (P<0.05); perioperative mainly phlegm and blood stasis syndrome, blood stasis based, mainly the late development of phlegm and blood stasis syndrome qi and phlegm and blood stasis syndrome based.Conclusion:1. Men in the pathogenesis of AMI are more than women, and more likely multivessel disease. Worsening angina pectoris stenting chance than onset angina patients. Bare-metal stents rate is too low, the blind expansion of the scope of application of drug-eluting stents.2. More difficult to control risk factors for poor patients after PCI, ACEI/ARB application rate, postoperative anxiety, insomnia, lack of professional rehabilitation exercise, lower quality of life problems to be solved, truly universal comprehensive cardiac rehabilitation medical model, the need for professional medical institutions and professional team effort.3. Patients after PCI are lack of rehabilitation knowledge,it is related to the cultural level and some clinicians consciousness about rehabilitation, and should strengthen the clinical education, rehabilitation physician awareness.4. Qi deficiency,phlegm, blood stasis after PCI is a high-level overview Syndrome elements of both the three independent existence, and influence each other, at different times focused. Syndromes after PCI in complex syndromes based, phlegm and blood stasis syndrome known as "Biao Shi" accounts for the main part, confirms the importance of promoting blood in phlegm Chest therapy. The "Ben Xu" will gradually emerge later, specimens wen is so fundamental treatment of coronary heart disease Dafa.