| Objective:To explore the distribution and change characteristics of TCM syndrome elements before and after endovascular treatment of ASO preliminarily,by observing the changes of TCM symptoms and signs.Then analyze the clinical practice value of syndrome differentiation in ASO.Methods:Adopting prospective observational research methods,choosing to be hospitalized in the Department of Peripheral Vascular Diseases of Xiyuan Hospital,China Academy of Chinese Medical Sciences,from July 2020 to November 2020,aged 40 to 80,diagnosed with ASO,and successfully underwent endovascular treatment.A total of 124 consecutive hospitalized patients were enrolled.Refer to"Syndrome Differentiation","Surgery of Traditional Chinese Medicine","Diagnostics of Traditional Chinese Medicine","Terms of Clinical Diagnosis and Treatment of Traditional Chinese Medicine·Symptom Part" to develop a scale to collect the patient’s general information,four diagnosis information,and surgical procedures.Before operation,after operation,1 month after operation,and 3 months after operation,the syndrome and element differentiation were performed respectively,and the relevant statistical analysis was carried out.Results:(1)The general situation of the patientIn this study,124 patients(131 limbs)with ASO treated by endovascular treatment in the Department of Peripheral Vascular Disease of Xiyuan Hospital were continuously enrolled,aged 40 to 80 years,81 males(65.3%)and 43 females(46.0%).There were 65 cases(52.4%)of people over 70 years old,95 cases(76.6%)of diabetes,105 cases(80.2%)of CLI,and 83 cases(63.4%)with foot ulcer or gangrene.Treatment methods included 68 cases(51.9%)with drug-coated balloon,47 cases(35.9%)with stent implantation,37 cases(28.2%)with volume reduction,and 20 cases(15.3%)with simple balloon expansion.All affected limbs successfully opened at least one direct blood flow to the foot.(2)Distribution characteristics of syndrome elements before endovascular treatmentThe distribution of preoperative syndrome factors was blood stasis(91 cases,73.4%)>kidney(51 cases,41.1%)>poison(49 cases,39.5%)>qi deficiency(46 cases,37.1%)>qi stagnation(33 cases,26.6%)>yin deficiency(31 cases,25.0%)>dampness(30 cases,24.2%)>liver(29 cases,23.4%)>spleen(27 cases,21.8%).The distribution of syndrome factors of complex diseases is in the order of combination of three syndromes(48 cases,38.7%)>combination of two syndromes(40 cases,32.3%)>combination of four syndromes(20 cases,16.1%)>single syndrome(13 cases,10.5%)>five syndrome elements and above(3 cases,2.4%).The syndrome differentiation is mainly composed of deficiency and excess(60 cases,48.4%),and the most common type of qi deficiency and blood stasis(10 cases,8.1%).Yang deficiency is positively correlated with end-point events such as postoperative target vessel reintervention,and the regression equation was Y=-3.188+2.746 X11(P<0.05).(3)Changes of syndrome factors after endovascular treatmentThe syndrome factors of solid disease decreased overall in the postoperative and 3-month follow-up process,and blood stasis was the most common.Compared with preoperatively,fever and toxicity decreased significantly in 3 months after operation(P<0.05);blood stasis decreased significantly after operation(P<0.01),and significantly decreased in 3 months after operation(P<0.05);qi stagnation decreased significantly after operation(P<0.05),and there was no statistical difference between 3 months after operation and before operation(P>0.05);although wetness had a downward trend during the postoperative follow-up period,there was no statistical difference(P>0.05).Deficiency and venereal syndrome factors increased overall during the postoperative and 3-month follow-up process,with qi deficiency being the most common,followed by yin deficiency.Compared with preoperatively,there was no significant change in the syndromes of deficiency and venereal disease after operation(P>0.05);qi deficiency and blood deficiency increased significantly in 1 month after operation(P<0.05);yin deficiency and yang deficiency did not occur during the postoperative follow-up period Increasing trend,but no statistical difference(P>0.05).Endovascular treatment has little effect on disease location syndrome elements,and the most common disease location syndrome element is kidney.Compared with preoperatively,the spleen increased significantly in 3 months after surgery(P<0.01);the heart and kidneys increased during the follow-up period,and the liver decreased,but there was no statistical difference(P>0.05).Among the changes in the distribution of complex syndrome factors,the combination of the three syndromes(48 cases,38.7%)was predominantly before the operation;the single syndrome(38 cases,30.9%)was the majority after the operation;1 month and 3 months after operation,the most common combination of the two syndromes,with 44 cases(44.9%)in 1 month and 46 cases(52.9%)in 3 months postoperatively.Deficiency of both qi and yin was the most common.Compared with preoperatively,the single syndrome was significantly increased after surgery(P<0.01),and it was significantly decreased at 1 month and 3 months after surgery(P<0.05),and there was no significant difference compared with preoperative(P>0.05);the combination of the two syndromes increased significantly at 3 months after the operation(P<0.01),and it increased significantly at 1 month and 3 months after the operation(P<0.05);the combination of the three syndromes decreased significantly after the operation(P<0.05),there was no significant difference between 1 month after operation and before and after operation(P>0.05).There was a significant increase in 3 months after operation compared with preoperative(P<0.05),but no significant difference compared with postoperative and 1 month after operation(P>0.05);the combination of four syndromes decreased significantly in 3 months after operation(P<0.05);Although the combination of five syndrome elements and above has a downward trend during the postoperative follow-up period,there is no statistical difference(P>0.05).Conclusion:(1)Blood stasis is the most common syndrome before and after endovascular treatment of ASO,with qi deficiency and blood stasis throughout.(2)The syndrome differentiation of ASO is more common in the combination of deficiency and excess.Before endovascular treatment,the predominance is solid.The postoperative deficiency is predominant,and complex syndromes are reduced.(3)Endovascular treatment has no obvious effect on location syndrome elements.(4)Yang deficiency is related to end-point events such as target vessel reintervention after endovascular treatment. |
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