| Neurogenic orthostatic hypotension(NOH)is a disorder of autonomic nervous system.It can occur in most multi system atrophy(MSA),partial Parkinson's disease(PD)and all pure autonomic failure(PAF).The clinical manifestations are dizziness,syncope,fatigue and burnout,which seriously affect the daily life of the patients.The prognosis of multi system atrophy is the worst,and the pathogenesis and prognostic factors are not completely clear.Although the treatment of NOH is getting more and more attention in clinic,there are few medicines available for treatment,and often lead to supine hypertension or other side effects.A certain clinical effect has been achieved in some research of traditional Chinese medicine.However,there are some shortcomings in clinical research reports in traditional Chinese medicine,including small sample or only case reports,lack of internationally recognized therapeutic evaluation criteria,and not randomized controlled.In the primary NOH disease,the prognosis of MSA is the worst.The prognostic factors that affect the survival period are not completely clear.The study on the survival period of MSA under the treatment of traditional Chinese medicine has not yet been reported.The effect of traditional Chinese medicine treatment on the prognosis of MSA is not clear.In this study,we observed the short-term clinical efficacy of "Yisui Decoction" in treating NOH,and the long-term survival of MS A patients under the treatment of "Yisui Decoction".1.The First Study:Therapeutic effect of Yisui Decoction in the treatment of neurogenic orthostatic hypotension with Pi-Shen deficiencyObjectiveBy using the prospective,randomized controlled method,introduction of internationally recognized Orthostatic Hypotension Questionnaire(OHQ)as the evaluation criteria,evaluate the clinical effect of Yisui Decoction in the treatment of neurogenic orthostatic hypotension(NOH).MethodIn a total of 60 patients were selected with neurogenic orthostatic hypotension,including multiple system atrophy,Parkinson's disease,and pure autonomic failure.The Chinese medicine dialectical type was Pi-Shen deficiency.The selected cases were randomly divided into 40 cases in the observation group and 20 cases in the control group.The observation group took "Yi sui Decoction" and the control group took " midodrine" for 4 weeks.The blood pressure of supine and orthostatic position,the score of the OHQ scale,the improvement of TCM syndrome score,the changes of the blood pressure in the supine position and the side effects were observed.Results60 cases were selected,and 1 case was lostinthe control group.In the 60 patients,40 were diagnosed as MSA,17 were PD,and 3 were PAF.The average age of the patients was 59.93 ±11.25 years,the proportion of male and female was 2.5:1,the course of disease was 3 months to 10 years,and the average course of disease was 3.51 ± 2.82 years.Most of the patients were in grade II and III of Symptom Grade of Orthostatic Intolerance.After treatment,the blood pressure of orthostatic position was higher than that before treatment in both group,while the control group was superior to the observation group.But at the same time,the blood pressure of supine position in the control group after treatment was also higher than that in the observation group.The change of blood pressure from supine toorthostatic position were significantly lower than those before treatment in both groups,andthere was no significant difference between the two groups.The changes of systolic pressure in the 4 weeks of the observation group was smaller than that in the observation group.The TCM syndrome score was improved after treatment in both groups,and the observation group was better than the control group,especially in the "waist" and "aversion to cold" and "constipation".After treatment,the total score of the OHQ scale in the observation group and the control group was improved,and the difference was not obvious between the two groups.In the single score,there was significantly improve in item 1 "dizziness/dizziness",item 2 "visual impairment",item 3 "weakness",item 4 "fatigue",item 7 "short time standing" and item 8"long time standing",with no significant difference between two groups.There was a moderate correlation between the OHQ compound score and changes of systolic pressure(rs = 0.440).ConclusionIn a short period of observation,there was a good clinical effect of Yisui Decoction in the treatment of neurogenic orthostatic hypotension with the TCM syndrome type of Pi-Shen deficiency.Yisui Decoction can reduce the main symptoms of NOH including dizziness,and it can decrease change of blood pressure from supine toorthostatic position,while has smaller impact on supine blood pressure.It can improve systemic symptoms more comprehensively than western medicine,and the patient is well tolerated.Symptoms of NOH have moderate correlativity with the change of blood pressure.2.The Second Study:Survival of multiple system atrophy treated with Yisui decoction plus western medicineObjectiveTo observe the clinical characteristics and survival of Yisui decoction plus western medicine in treating multiple system atrophy patients,andanalysis prognostic factors of multiple system atrophy.MethodReviewed the cases of multiple system atrophy treated with traditional Chinese medicine plus western medicine between 2006-2010 in China and Japanese hospital.Collected the general situation,the course of disease,the first symptoms,the TCM syndromes,the treatment.All cases were followed up by telephone to record the patient's condition.Recorded the time and the cause of death.Results82 cases were selected with 20 MSA-P,44 MSA-C and 18 P+C.There were 46 males and 36 females.The age of onset was 39-78 years,and the average age was 56.94±6.91 years old.49 cases of "Yisui Decoction group" and 33 cases of "non-Yisui Decoction group".17 cases were lost and 65 cases were followed up.Gan-Pi-Shen deficiency was most common syndrome.42.7%of the patients had a prodromal premotor phase,including autonomic symptoms and rapid-eye-movement sleep behavior disorder.After onset of motor symptoms,patients were characterized by progressive autonomic failure,parkinsonian features,and cerebellar and pyramidal features in various combinations.In the late stages of the disease,patients required a wheelchair,often had unintelligible speech,gastrostomy,indwelling catheter,recurrent falls,they were even bedridden or tracheostomy.The disease is developing rapidly,and the quality of life is lowafter middle stage.In the 65 cases,51 were dead with the survival period of 3-11 years,and 14 cases survived with the survival period of 8-15 years.The causes of death were pulmonary infection and respiratory failure in 27 cases(54%),sudden death in 8 cases(16%),multiple organ failure in 8 cases(16%),urinary tract infection in 4 cases(8%),asphyxia in 2 cases,myocardial infarction in 1 cases,liver cancer in 1 cases.Fall is an important cause of the aggravation of the disease.The average survival time of all patients was 8.76 10.74 years,which was 8.99±0.79 years of "Yisui Decoction group".Age over 60 is a factor associated with poor prognosis.Gender,P/C type and the first symptom were not related to the prognosis.ConclusionMultiple system atrophy is developing rapidly,with short survival time and poor prognosis:The average survival time of multiple system atrophy was 8.99±0.79 years under the treatment of Yisui decoction plus western medicine..Compared with other treatments,the survival time did not prolong significantly,but there were individual cases with a longer survival period and a late disability time in the Yisui Decoction group.Pulmonary infection and respiratory failure are the most common cause of death.Factor associated with the poor prognosis was more than 60 years old,while gender,P/C type and the first symptom were not related to the prognosis. |
PDF Full Text Request