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The Clinical Study on the Effects of Percutaneous Coronary Intervention on Coronary Heart Disease with Qi Deficiency-blood Stasis Syndrome

Author: LiJian
Tutor: ZhangMinZhou
School: Guangzhou University of Traditional Chinese Medicine
Course: Traditional Chinese Medicine
Keywords: percutaneous coronary intervention Qi deficiency - blood stasis syndrome blood stasis syndrome core Qi deficiency syndrome core function of endothelial cell Tong Guan Capsule
CLC: R259
Type: PhD thesis
Year: 2007
Downloads: 274
Quote: 1
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Abstract


ObjectiveThis study aims at exploring the distribution of TCM syndromes incoronary heart disease before and after percutaneous coronaryintervention. The pathological changes of coronary heart disease withblood stasis syndrome were observed to evaluate the effects ofpercutaneous coronary intervention on blood stasis syndrome. Theeffectiveness and principles of treatment of blood stasis syndrome afteroperation using Tong Guan Capsule were also investigated. This studyprovides a useful base for application of TCM on post-operation ofpercutaneous coronary intervention.Methods1. 445 patients of coronary heart disease were selected in the study bycoronary angiography. The syndrome differentiation type of TCM of thepatients were differentiated adopting the standard of syndromedifferentiation for coronary artery disease revised in 1990. Therelationship between the coronary angiography reflected degree ofcoronary artery lesion and the syndrome differentiation type of TCM wasanalyzed.2. 60 patients of coronary heart disease with successful percutaneouscoronary intervention were divided into the control group (25 patientswith Qi deficiency-blood stasis syndrome, routine treatment), the TongGuan Capsule group(25 patients with Qi deficiency-blood stasissyndrome, routine treatment plus Tong Guan Capsule)and non-Qideficiency-blood stasis syndrome group. The syndrome differentiationtype of TCM, Qi deficiency syndrome core, blood stasis syndrome core were evaluated. The levels of the blood NO, ET, TXB2, 6-Keto-PGF1a, MPV and PDWwere examined in the time of one day before operation, three days afteroperation and thirty days after operation of percutaneous coronaryintervention, respectively. Doppler ultrasound color cardiogram was usedto test LVEF, CO and SV in the time of one day before operation and thirtydays after operation of percutaneous coronary intervention,respectively.Results1. The syndrome differentiation type of TCM results showed that bothpre-operation and post-operation of percutaneous coronary intervention,the most syndrome type in all patients of coronary heart disease were ofQi deficiency-blood stasis syndrome. Patients with Qi deficiency-bloodstasis syndrome were 136 (30.6%) before operation and 84 (34.0%) afteroperation, respectively. Follow-up survey found 12 (28.6%) patients wereof Qi deficiency-blood stasis syndrome in the restenosis case. Comparedwith pre-operation, the cases with Qi deficiency syndrome and withPhlegm-Turbid syndrome were increasing in post-operation of percutaneouscoronary intervention. However, the cases with blood stasis syndrome weredecreasing. Among the patients of coronary heart disease with Qideficiency-blood stasis Syndrome, 51.4% patients were mild stenosis;34.8% patients were moderate stenosis and 23.5% were severe stenosis.55.9% patients were of one-artery lesion and 23.5% were of two-arterylesion. The score of was of coronary artery lesion with Qi deficiency-blood stasis syndrome was 32.9±11.0, that was significantly lower thanQi deficiency- Phlegm-Turbid syndrome, Qi deficiency- Phlegm-Turbid-blood stasis syndrome, Yang deficiency- Phlegm-Turbid-blood stasissyndrome and Phlegm-Turbid-blood stasis syndrome (p<0.05). The scoreof was of coronary artery lesion with Qi deficiency syndrome was 52.7±23.9, that was significantly lower than Yang deficiency syndrome andYang collapse syndrome. The score of was of coronary artery lesion withblood stasis syndrome was 32.1±22.9, that was significantly lower thanPhlegm-Turbid syndrome and cold condensation syndrome.2. Compared with pre-operation, blood stasis syndrome core wassignificantly decreasing after three days of post-operation ofpercutaneous coronary intervention but Qi deficiency syndrome score was increasing (p<0.05). Statistic difference of angina betweenpre-operation and post-operation was significant (p<0.05). However,Statistic difference of tongue and pulse state between pre-operation andpost-operation were not significant (p>0.05). Compared with the group oftreatment with chemosynthetic drug, in the group of treatment with TongGuan Capsule blood stasis syndrome core was significantly decreasing andQi deficiency syndrome score was also decreasing (p<0.05) after thirtydays of post-operation of percutaneous coronary intervention.3. Compared with pre-operation, the value of ET、TXB2、MPV and PDW weresignificantly increasing (p<0.05) but the value of 6-Keto-PGF1a and NO weresignificantly decreasing (p<0.05) after three days of post-operation ofpercutaneous coronary intervention. Compared with the group of treatmentwith chemosynthetic drug, in the Qi deficiency-blood stasis syndromegroup of treatment with Tong Guan Capsule the value of ET、TXB2、MPV andPDW were decreasing (p<0.05) but the value of 6-Keto-PGF1a and NO weresignificantly increasing (p<0.05) after thirty days of post-operation ofpercutaneous coronary intervention. Compared with pre-operation, in theQi deficiency-blood stasis syndrome group of treatment with Tong GuanCapsule the value of EF、SV and CO significantly increasing (p<0.05) afterpercutaneous coronary intervention.Conclusions1. The most syndrome type in both coronary heart disease and restenosispost-operation of percutaneous coronary intervention were Qideficiency-blood stasis syndrome.2. The pathological changes in coronary heart disease with blood stasissyndrome were not severe. The degrees of pathological changes in coronaryheart disease with blood stasis syndrome is the most mild compared withQi deficiency- Phlegm-Turbid syndrome, Qi deficiency- Phlegm-Turbid-blood stasis syndrome, Yang deficiency- Phlegm-Turbid-blood stasissyndrome and Phlegm-Turbid-blood stasis syndrome (p<0.05).3. Percutaneous coronary intervention could effectively decrease bloodstasis syndrome core by eliminating angina. Percutaneous coronaryintervention aggravated blood stasis syndrome due to that inmicrophenomenon percutaneous coronary intervention aggravateddysfunction of endothelial cell. Percutaneous coronary intervention could increase Qi deficiency syndrome core resulting in aggravating Qideficiency syndrome.4. Treatment with Tong Guan Capsule could improve the aggravation of Qideficiency syndrome and blood stasis syndrome in post-operation ofpercutaneous coronary intervention. It implied that the principle ofYiqihuoxuejiedu is the effective treatment in post-operation ofpercutaneous coronary intervention.

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