| Objective: To evaluate the effect of combined treatment of traditional Chinese and western medicine on chronic heart failure through a retrospective study and provide theoretical and practical basis for further improvement of clinical pathway of chronic heart failure(CHF).Methods: Based on non-randomized retrospective history research,160 cases with CHF were divided into two groups: combined treatment of traditional Chinese and western medicine group(pathway group)and conventional western medicine treatment group(convention group),with 80 cases in each group through.For two groups,average length of hospitalization,average hospitalization expenses,expense for each item during hospital stay,blood pressure,heart rate,improvement in TCM symptoms and cardiac function,common-used drugs in hospital were observed.And a follow-up was made for medication taking and mortality at the end of this study.Besides,difference between two groups was evaluated after data input and analysis through SPSS l9.0 statistical software.Results: 1.In terms of the average length of hospitalization,compared with the conventional group,the path group has a downward trend.(12.10±3.66 d vs 12.88±4.84d),while there was no statitical significance between them(P>0.05);there was statistical significance(P<0.05)between cases with cardiac function of NYHA II(7.00 ± 0.00 d vs 8.43±2.82d)and IV(13.17±4.11 d vs 15.82±7.32d)respectively in two groups,but there was no statistical significance between cases with cardiac function of NYHA III of two groups(P>0.05).2.In terms of comparion of average hospitalization expenses between two groups,the pathway group was less than that of convention group(￥10380.49 ± 4201.96 vs ￥13964.17±8049.31),and the difference was statistically significant(P<0.05).When it comes to the comparison of average hospitalization expenses between cases with different cardiac function classifications of two groups(￥10607.91 ± 2834.63 vs ￥9175.32±6147.99),the difference was not statistically significant except the factor of little samples with NYHA II.Cases with cardiac functions of NYHA III(￥9891.08±3950.83 vs ￥12652.23±5392.76)and IV(￥11067.98±4695.29 vs ￥19217.71±12147.80)in pathway group spent less averagely during hospitalization than convention group,and there was statistical significance between them(P<0.01).Except the expenses in bed,nursing,radiology and labs,clinical pathway can reduce expenses in western medicine,inspection,treatment and other aspects.3.The difference of pre-treatment and post-treatment systolic blood pressure and diastolic blood pressure for two groups was not statistically significant(P>0.05).Compared to pre-treatment heart rate,the heart rate of cases in both groups decreased significantly,which indicated there was statistical significance between them(P<0.01).There was no statistical significance(P>0.05)in terms of comparisons of pre-treatment and post-treatment systolic and diastolic blood pressure and heart rate of cases in two groups,and difference in improvement in TCM symptoms between two groups was not statistically significant(P>0.05).Difference in improvement in cardiac function between two groups was statistically significant(P<0.05),which suggest clinical pathway group convention group shared similar general clinical efficacy in control blood pressure,heart rate,symptoms and so on.While pathway group achieved better improvement in cardiac function than convention group.4.By making comparisons of common-used drugs between two groups during hospitalization,we found that the common use of drug on the first day admission of the two groups of patients,the use of beta blockers in convention group was higher than that of pathway group,which suggest there was significant difference between them(P<0.05),while for other medications like ACEI / ARB,aldosterone receptor antagonists,venous expansion agents and intravenous diuretics,there were not statistically significant(P>0.05).When it comes to the use of ACEI / ARB and beta blockers of two groups on the last day of hospitalization,there was no significant difference(P>0.05)between them,but the difference of aldosterone receptor antagonists and venous vasodilation agents use was statistically significant(P<0.05).And the use of ACEI/ARB,beta blockers and aldosterone receptor antagonistson the last day of hospitalization was much more than that of convention group,and the use of intravenous agents was much less than that of the convention group.5.There was no statistical significance in terms of the use of ACEI/ARB and beta blockers between the two groups(P>0.05)by making the follow-up.The use of aldosterone receptor antagonists of pathway group was significantly higher than that of convention group,and the difference was statistically significant(P<0.01).And there was no statistical significance in terms of mortality from discharge to the end of the project between two groups(P>0.05)Conclusions: 1.The clinical pathway of combined treatment of traditional Chinese and western medicine has the trend of reducing the average length of hospitalization of cases with CHF after retrospective study of combined treatment of traditional Chinese and western medicine group and the convention group.2.The clinical pathway of combined treatment of traditional Chinese and western medicine can reduce the average hospitalization expenses and expense of some items for cases with CHF.3.Compared to convention group,the clinical pathway of combined treatment of traditional Chinese and western medicine can improve the cardiac function better,while the general clinical efficacy in control blood pressure,heart rate,symptoms of two groups was much silmilar.4.In terms of medication adjustment during hospitalization,the pathway group was laid more emphasis on drugs to slow down the ventricular remodeling,especially those aldosterone receptor antagonists.5.When it comes to the use of ACEI/ARB and beta blockers of the two groups,the difference between them was not significantly different,while the use of aldosterone receptor antagonists of pathway group was greatly much more than that of convention group.There was no significant difference in mortality between two groups after the cases were discharged from the hospital. |
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