Clinical Retrospective Analysis Of Three Cases Of Acute Pulmonary Heart Disease Caused By Structural Lung Disease Treated By Integrated Traditional Chinese And Western Medicine

Background Structural lung disease is caused by a variety of causes,airway stenosis,obstruction,distortion,wall thickness hardening,and so on.Or airway cilia,mucous gland hyperplasia,and distal airway expansion changes,resulting in irreversible airway structure.A group of diseases prone to repeated lung infections.There is no clear definition.It mainly includes COPD,bronchiectasis,pulmonary fibrosis,etc.Structural lung disease is common in the respiratory department.It can lead to deficiency of ventilation,dispersion disorder,ventilation-blood flow imbalance and the presence of intrapulmonary shunt.Lead to hypoxia and hypercapnia,patients caused by pulmonary artery contraction,at the same time,the existence of pulmonary vascular remodeling and vascular bed was damaged and local lung small artery thrombosis,leads to pulmonary hypertension and cor pulmonale.Various structural lung diseases have long been closely watched by various professional societies.In addition,the corresponding diagnosis and treatment guidelines were developed,and pulmonary heart disease,as a serious complication of structural lung disease,was only a blip in the formulation of the guidelines.Therefore,it is of vital importance to carry out the clinical characteristics of patients with pulmonary heart disease caused by various structural lung diseases and the research of traditional Chinese and western medicine.It is helpful for clinicians to improve the understanding of pulmonary heart disease caused by different structural lung diseases and to further choose the strategy of TCM diagnosis and treatment.Objective Through the retrospective analysis,summarize and analyze the different structural lung disease caused by lung the clinical characteristics of acute phase and the experience of diagnosis and treatment of traditional Chinese and western medicine,and make an objective and credible evaluation to guide the clinical decision making.Methods By chengdu university of traditional Chinese medicine hospital electronic medical records system,and the doctor’s advice,the patients with relevant data,in October2015-January 2018 in sichuan province,Chinese medicine hospital respiratory diagnosed by three kinds of common structural lung disease(COPD),bronchiectasis,pulmonary fibrosis caused by acute aggravating period of cor pulmonale patients as the research object,make retrospective information collection table,the main record of the patient’s general condition: gender,age,course of the disease,smoking,occupational dust exposure,hospitalization days,clinical performance: cough,cough up phlegm,palpitations,shortness of breath,my diet,then the sound,edema,tongue and pulse condition,auxiliary examination: Inflammatory indicators(calcitonin original),blood coagulation function(fibrinogen and D dimer),heart failure index(BNP)and electrolyte(K +,Na +),nutritional index(albumin),blood gas analysis(PCO2,PO2),etiology,1 week before antibiotics usage in hospital,TCM syndrome type and intervention measures and effects of Chinese and western medicine project registration list,application SPSS22.0 statistical analysis software,the results and analysis.Results 1.Among the patients enrolled in this study,the total number of patients with acute exacerbation of pulmonary heart disease due to the selection criteria of cases was 120,76 males and 44 females.The average age is 66.5,plus or minus 11.3 years,and the youngest is 37,and the oldest is 86;The proportion of patients with smoking history(occupational dust exposure history)is as high as 60%;The average length of hospitalization in patients with acute exacerbation of pulmonary heart disease caused by single structural lung disease was 14.4 + 3.7 days,the longest 22 days,and the shortest 6 days.The mean duration of the disease was 17.8 + 14.9 years,the shortest course was 4 years,and the longest duration was 50 years.2.COPD patients who suffered heart disease from lung disorders caused by acute exacerbation phase frequency of the top three symptoms: cough,cough up whitePaoMoTan,diet to reduce,the most common tongue is dark red tongue,coating is white and greasy moss,pulse condition of slippery pulse;Bronchiectasis disease caused by patients who suffered heart disease from lung disorders in acute aggravating period frequency of the top three symptoms: cough,cough up phlegm or yellow thick phlegm,diet to reduce,the most common tongue is dark red tongue,tongue coating for yellow greasy moss,pulse condition of slippery pulse;Pulmonary fibrosis caused by patients who suffered heart disease from lung disorders in acute aggravating period frequency of the top three symptoms: cough,phlegm,wheeze and shortness of breath,the most common tongue is dark red tongue,tongue coating for thin white moss,pulse condition for heavy fine veins.3.1 week before antibiotics use number for 81 cases of hospitalized,67.5%(81/120),the total number of 115 patients with antibiotics after admission,accounted for 95.8%(115/120),the first dose of antibiotics selection to beta lactam class(+enzyme inhibitors),the most common for 80 cases,accounting for 69.6%(80/115);The first dose of antibiotic treatment failure rate was 9.2%(11/120),the main reason for(1)(2)in left heart failure and other complications develop pseudomonas aeruginosa,acinetobacter baumannii,etc.,and often for drug-resistant bacteria(3)pathogenic microorganisms for fungal infection.4.According to the occurrence frequency of TCM syndromes,the occurrence frequency ranges from high to low,with the incidence of phlegm heat and obstructed lung syndrome(39.1%),phlegm dampness and lung syndrome(29.1%),cold drink and lung syndrome 22(20%),and Yang deficiency water(11.8%).5.After combining traditional Chinese and western medicine treatment of cough,cough up phlegm,palpitations,shortness of breath,diet is the main symptoms,signs such as edema,then the sound,and its total score than before treatment significantly improved(P < 0.01),calcitonin,BNP,PCO2,fibrinogen and D-dimer was decreased(P < 0.05),the albumin,PaO2,significantly higher than before treatment(P < 0.01),the total effective rate was 91.7%,the fatality rate was 2.5%(3/120),death main the cause of death in patients with severe pulmonary infection and malignant arrhythmia,respiratory failure,pulmonary encephalopathy,severe electrolyte disorder,etc.,are allold In the year of the patient,with the majority of men,the age is larger,the course of disease is more than 20 years.Conclusion 1.In this study three common structural lung disease caused by the cor pulmonale patients with acute aggravating period in the majority with men,elderly people for their good hair,the long course of the disease,most patients with a history of smoking,occupational dust exposure,so quit smoking,and the prevention of occupational dust exposure,timely and effective structural lung disease prevention and control in reducing the incidence of the resulting cor pulmonale is important.2.Serum PCT concentrations in three common structural lung disease caused by cor pulmonale with acute aggravating period of diagnosis and guidance of antibiotics application has unique advantages,and according to the PCT level to reflect the severity of the infection;Elevated levels of plasma D-dimer,Fib,and with the corresponding changes after treatment,the assessment of disease severity,monitoring the complications such as pulmonary embolism,and further to evaluate prognosis has certain clinical value;The BNP contributes to the early rapid diagnosis and severity of chronic cor pulmonale,as well as an important reference for evaluating the therapeutic effect of pulmonary heart disease.Serum albumin can be used as a laboratory index to monitor pulmonary heart disease and chronic malnutrition.Clinicians should be in time for the various structural lung disease caused by cor pulmonale patients with acute aggravating period of blood gas analysis examination,the assessment of patients with acute aggravating period of chronic cor pulmonale disease progression and change,judge the prognosis has an important role.3.Pre-hospital antibiotics abuse significantly,greatly increasing the pathogen resistance and adverse reactions caused by its structural lung disease caused by lung pathogenic microorganism bacterium spectrum change,sputum culture positive for pathogenic microorganisms with G-is given priority to,choose to G-sensitive antibiotic clinical experience,and fully consider the common pseudomonas aeruginosa resistant bacteria such as infection,can improve the success rate of firstdose of antibiotics,and can reduce or avoid double infection caused by abuse of antibiotics,use empirical antibiotic therapy in time repeated inspection pathogenic microorganism inspection,stay clear etiology can be adjusted according to patients condition again after drug use.4.Pay attention to maintain internal environment stability,prevent electrolyte disturbance,improve the patient’s diet,timely nutrition support treatment.5.Three common structural lung disease caused by lung disease resistance standard for this virtual to real,more factors and pathogenesis for feeling when be real,be at ordinary times this deficiency,phlegm,drinking,blood stasis for structural lung disease lead to cor pulmonale with acute aggravating period of common pathological factors,treatment are mainly composed of exorcism the centralizer.6.The combined treatment of Chinese and western medicine is remarkable for the acute exacerbation of pulmonary heart disease caused by various structural lung diseases.