Development Of A Diagnostic Scale Of Integrated Traditional Chinese And Western Medicine For Different Pathological Factors Of Chronic Heart Failure

Objective: Develop an integrated traditional Chinese medicine and western medicine diagnostic scale for different pathological factors of chronic heart failure,Provide guidance for the clinical diagnosis of chronic heart failure.Methods:1.Use computer to search for literature on chronic heart failure,collecting related symptoms,signs,physical and chemical indicators,obtaining a collection of indicators that reflect the main Chinese and Western medical diagnosis of the disease syndrome,and forming a pool of literature entries.Selecting entries with the principal component analysis combined with the Apriori algorithm correlation analysis,formulate an expert questionnaire.2.An expert questionnaire survey was conducted through the Delphi method.The steps are:(1)Establish a research working group;(2)Select experts;(3)Develop expert consultation questionnaire and complete two rounds of investigation;(4)Set up diagnostic index scores and total scores according to statistics and analysis of mean,maximum rate,rank sum scores,variation coefficient and weight coefficient.Preliminary drafting a diagnostic scale for integrated TCM and western medicine for different pathological factors of chronic heart failure.Results: 1.A total of 6,000 articles are found from the literature research,and 161 articles are included.A total of 175 diagnostic items of 6 main pathological factors including Qi deficiency,Yang deficiency,Yin deficiency,Blood stasis,turbidity and fluid retention are extracted.2.The expert questionnaire selects 6 main pathological factors of chronic heart failure including Qi deficiency,Yang deficiency,Yin deficiency,blood stasis,turbidity,and fluid retention.There are 17,15,11,11,11 and 17 diagnostic items respectively.In terms of macro indicators: Qi deficiency includes fatigue,shortness of breath,palpitations,faintness pulse,spontaneous sweating,mental fatigue,weak pulse,basic cardiovascular disease,cardiac function grade ???,chest tightness,shallow white complexion;Yang deficiency includes Palpitations,chills and cold limbs,white and slippery tongue fur,gasp,edema of extremities,shortness of urine,shortness of breath,inability to lie down,pale complexion,cardiac function grade ???,basic cardiovascular disease,bluishpurple complexion;Yin deficiency includes Red tongue,thirst,night sweat,pulse deficiency and fast,hot feeling in the center area of hands and foot,sweating,dry mouth and throat,irritability,upset,difficulty falling asleep;Blood stasis includes tongue with petechia and ecchymosis,cyanosis of lips,dull complexion,dull or gloomy tongue,uneven pulse,chest tightness,jugular vein enlargement,cardiac function grade ???;turbidity includes vomiting thin white sputum,thick fur,heavy limbs,obesity,greasy fur,slippery pulse,dark or cloudy or dull complexion,consciously feeling of phlegm in the pharynx,spitting foamy sputum;fluid retention includes edema of extremities,gasp,shortness of urine,edema of face,pleural and abdominal effusion,cough and spit thin and white phlegm,white and slippery tongue fur,irritability,deep and thready pulse,spitting foam phlegm,inability to lie down,basic cardiovascular disease,chills and cold limbs,white and wet fur,chest tightness,slippery pulse.In terms of Physical and chemical indicators: Qi deficiency includes 6MWT reduced,LVEF decreased,BNP increased,Abnormal SV,abnormal CO,E/A?1;Yang deficiency includes LVEF decreased,BNP increased,NT-pro BNP increased,Yin deficiency includes abnormal CO,Blood stasis includes large X-ray heart shadow with pulmonary congestion and edema,6MWT reduced,LVEF decreased;turbidity includes large X-ray heart shadow with pulmonary congestion and edema,lung capacity reduced by 1/3 of its maximum value,fluid retention includes BNP increased.Conclusion: This study is based on the idea of disease differentiation by Western medicine and syndrome differentiation by TCM,taking pathological factor as the main point of research,which develops a draft diagnostic standard of integrated TCM and Western medicine for different pathological factors of chronic heart failure in the form of scale.This scale has certain reliability and practicability through literature research and Delphi method expert questionnaire survey and subjective and objective comprehensive analysis.This scale provides guidance for the clinical diagnosis of chronic heart failure by integrated TCM and western medicine,and provides a reference for treatment and medication.