Clinical Features And TCM Syndrome Differentiaiton And Treatment Analysis Of The Vulnerable Phase After Hospitalization For Heart Failure

Objective : To explore the clinical features and TCM syndrome differentiaiton and treatment analysis of the vulnerable phase after hospitalization for heart failure,and to further explore the diagnosis and treatment basis of the vulnerable phase after hospitalization for heart failure,providing clinical basis and reference for the early prevention and treatment of the combination of Chinese and Western Medicine.Methods: 176 patients with heart failure admitted to the cardiovascular center and ICU ward of Affiliated Hospital of Gansu University of traditional Chinese medicine from January2019 to June 2020 were collected.According to whether there was any readmission and death within 90 days after discharge(the vulnerable phase after hospitalization for heart failure),44 patients with adverse prognosis and 132 cases of good prognosis were divided into two groups.The questionnaire of clinical data was completed,including basic data(sex,age,past history,hospitalization days,etc.),etiology,complications,hematological indexes(blood routine,biochemistry,coagulation,thyroid function,N-terminal pro-brain natriuretic peptide),cardiac color ultrasound(ejection fraction,pulmonary artery pressure,left atrial diameter,left ventricular end diastolic diameter),therapeutic drugs and TCM Syndromes,TCM treatment,etc.The data were sorted out,the database was established,and the two groups of data were analyzed and compared by SPSS 21.0 statistical software.To observe the clinical features,risk factors and the principle of TCM syndrome differentiaiton and treatment principle in the vulnerable phase after hospitalization for heart failure.Results:1.The results showed that there were 176 patients with heart failure,99 males(56.25%),77 females(43.75%),and 35(19.9%)patients who were discharged from hospital within 90 days.7 cases died in hospital,2 died outside hospital,9 died(5.1%)all due to death.2.The basic data of the two groups showed that there was no significant difference in sex,age,hospitalization days,history of previous heart failure,etiology,inducement and common symptoms among the two groups,while there were differences in blood pressure,complications and cardiac function classification.3.The leukocyte,total bilirubin,SCR,BUN,UA,D-dimer and NT-pro BNP in the group with adverse prognosis were higher than those in the good prognosis group,while the hemoglobin,RBC,hematocrit and sodium in the adverse prognosis group were lower than those in the good prognosis group.4.There was no significant difference in LVEF,left atrial diameter,left ventricular end diastolic diameter and pulmonary artery pressure between the two groups.5.There was no significant differences between the two groups in the use of diuretics,aldosterone receptor antagonists,ACEI/ARB,β receptor blockers,anticoagulants and ARNI among the two groups.Compared with the good prognosis group,the positive myodynamite use rate of the adverse prognosis group was higher.6.The results of logistic regression analysis showed that the high level of creatinine(OR=1.031,95% CI:1.016-1.046),high blood uric acid(OR=1.005,95% CI:1.001-1.009),leukocytes(OR=1.175,95% CI:1.52-1.313),were the risk factors for poor prognosis in the vulnerable phase after hospitalization for heart failure,while the haemoglobin(OR=0.954,95% CI:0.929-0.980)was the protective factor for reducing the adverse prognosis.7.The ALT,AST,TSH,and UA of HFpEF patients in the adverse prognosis group were significantly lower than those in the HFmrEF group.The total bilirubin and direct bilirubin in the HFpEF patients were significantly lower than those in the HFrEF group and the proportion of coronary heart disease patients in the HFpEF group was lower than that in the HFrEF and HFmrEF groups.8.There was statistical difference in the distribution of syndrome types between the two groups.The patients with the adverse prognosis group were more likely to show the syndrome of Yang deficiency and water flooding and thd exhaustion of Yin and Yang.There were significant differences in the distribution of hemoglobin levels between the Yang deficiency and water flooding syndrome group and Qi deficiency and blood stasis syndrome group,between the Yang-deficiency and water exhaustion group and the exhaustion of Yin and Yang group,while there was no statistical significance between other groups.There was no significant difference in the levels of leukocyte,creatinine and uric acid among the syndrome types.9.The difference between the two groups of patients in the TCM treatment group was statistically significant,and patients who used TCM treatment more often had fewer adverse outcomes.Patients in the good prognosis group used proprietary Chinese medicines and external TCM treatments more.The most frequently used Chinese patent medicine is Qiliqiangxin capsule,followed by Danshen injection and Xinmailong injection.The most used types of Chinese medicines are qi-tonifying medicines,blood activating and removing blood stasis medicines,and medicines to warm yang.The most commonly used TCM external treatment methods are moxibustion,acupoint application,and foot bath.Conclusion:1.The group with adverse prognosis has more complications,heart rate,systolic blood pressure,diastolic blood pressure,white blood cells,total bilirubin,blood creatinine,blood urea nitrogen,blood uric acid,D-dimer,and NT-Pro BNP are higher than those of the good prognosis group.Hemoglobin,red blood cells,hematocrit,and blood sodium were lower than those in the good prognosis group..2.High blood creatinine,hyperuricemia,increased white blood cells,and anemia are risk factors for poor prognosis in the vulnerable phase after hospitalization for heart failure.3.The clinical manifestations of patients in heart failure with different ejection fractions were different.4.The patients in the group with adverse prognosiswere more likely to show the syndrome of Yang deficiency and water flooding and exhaustion of Yin and Yang.Hemoglobin levels can be used as an objective reference index of TCM syndrome differentiation.The increase of the use of traditional Chinese medicine can reduce adverse events,and the treatment of traditional Chinese medicine embodies the characteristics of the combination of Chinese and Western medicine in the treatment of heart failure.