Percutaneous coronary intervention (PCI) is an effective treatment for acute coronary syndromes, which can relieve angina pectoris and increase coronary circulation more quickly, and has the advantages of accurate diagnosis, significant efficacy and small trauma. However, restenosis, recovery of cardiac function, and emotional disorders are still the main clinical problems after PCI, so the rehabilitation of patients with coronary artery disease, especially the rehabilitation of patients after PCI, is an important measure related to their quality of life and prognosis, which has attracted extensive attention from scholars at home and abroad.
The application of combined Chinese and Western medicine in the rehabilitation of patients with coronary heart disease after PCI is a medical practice in which two different theoretical systems of medicine interpenetrate and complement each other’s strengths, which can not only significantly improve the efficacy and shorten the course of treatment, but also improve the exercise capacity of patients with coronary heart disease, promote their psychosocial health, improve their quality of life, reduce the readmission rate of patients with coronary heart disease, thus reduce hospitalization costs, etc. From the understanding of Chinese and Western medicine on coronary heart disease, combined with the clinical experience of teachers and personal practice experience, the author will discuss the postoperative rehabilitation treatment mode of Chinese and Western medicine for coronary heart disease PCI.
1.New understanding of Chinese and Western medicine on coronary heart disease rehabilitation
In the past 30 years, the medical rehabilitation of coronary heart disease centered on cardiac rehabilitation exercise and psychotherapy has accumulated a lot of experience, and has made significant progress in shortening hospitalization days, reducing hospitalization costs, and lowering mortality and disability rates, gradually forming a comprehensive cardiac rehabilitation treatment program, which has become an integral part of cardiovascular disease medical treatment. The content of rehabilitation includes prescribed exercise therapy, psychological, nutritional, educational, vocational and social counseling, etc., so that patients with coronary heart disease can obtain a normal or near-normal living condition through comprehensive cardiac rehabilitation medical treatment. Also cardiac rehabilitation is not limited to heart disease, but should include treatment of risk factors, such as hypertension, obesity, hyperlipidemia and diabetes, in the rehabilitation program. According to Chinese medicine, coronary heart disease belongs to the category of “chest paralysis and heart pain” in Chinese medicine, and its basic pathogenesis is a deficiency of the internal organs of Qi, blood, yin and Yang deficiency, dysfunction; phlegm, blood stasis, cold and gas stagnation, such as paralysis of the heart Yang, blocking the heart arteries as the standard. PCI is an invasive treatment, which has a similar effect of “breaking blood” and easily depletes the vital energy, which may cause the symptoms of deficiency to worsen.
The signs of loss of glory of the heart pulse are more obvious. Therefore, the fundamental purpose of post-operative rehabilitation of coronary artery disease PCI is to restore the function of the heart’s blood vessels. The main measures include drug rehabilitation, exercise rehabilitation, emotional rehabilitation, dietary rehabilitation, living rehabilitation, medicinal food rehabilitation and other means, in order to carry out comprehensive conditioning and achieve comprehensive rehabilitation. The rehabilitation of coronary heart disease in TCM has the advantages of both physical and spiritual nurturing, primary and secondary treatment, multi-target, multi-path and multi-link intervention and individualized treatment, and the organic combination of Western medicine and Western medicine to form a comprehensive rehabilitation of Chinese and Western medicine, which undoubtedly helps to improve the efficacy.
2. Combination of Chinese and Western medicines to jointly prevent and treat restenosis
With the widespread development of interventional technology, the incidence of restenosis after percutaneous transluminal coronary angioplasty (PTCA) has been found to be as high as 30% to 40%, even after stent implantation, the incidence is 15% to 20%, and most restenosis occurs within 3 to 6 months after the procedure. Restenosis after coronary stenting has become the focus and problem of coronary intervention. The mechanism of restenosis after coronary stenting is still unclear, and clinical reports vary. Most scholars believe that restenosis after intervention is an excessive repair response after local vascular injury, which eventually leads to intimal thickening and restenosis formation after intervention, and is also closely related to risk factors such as poor lifestyle habits, hypertension, hyperlipidemia, diabetes, cold stimulation, emotional excitement, infection, and exertion. The means of prevention and treatment mainly include drug prevention, gene therapy, intravascular radiation therapy, drug-coated stents and so on.
In recent years, Western medicine has made great progress in the prevention and treatment of restenosis after stenting of coronary artery disease, especially the emergence of drug-coated stents, whose special advantage is to reduce the rate of restenosis and the rate of hemodynamic reconstruction, and the literature reports that the rate of restenosis can be reduced by 5%-10% and the blockage of blood vessels by 2%-3%, so it is widely used in clinical practice. However, although drug-coated stents improve the prognosis of coronary interventions, they also bring many new problems: the coating drugs inhibit the proliferation of smooth muscle cells and the regeneration of normal endothelial cells, resulting in delayed endothelialization after stent implantation and increasing the risk of late thrombosis. In addition, the possibility of aneurysm is also increased due to the thinning of the vessel wall.
Therefore, restenosis after coronary stenting remains a major clinical problem in the treatment of coronary artery disease. The understanding of post-PCI restenosis and its prevention is a new field and a new topic in contemporary Chinese medicine for the treatment of coronary heart disease. At present, some famous scholars such as Deng Tietao, Chen Keji and Zhang Minzhou have made useful discussions and practices, and the results are promising.
We believe that coronary heart disease is characterized by “deficiency at the root and solid at the symptoms” throughout the entire course of the disease, and that PCI can be classified as a treatment method for “eliminating evil” in Chinese medicine, which has the function of “activating blood and breaking stasis” and can This leads to the damage of the dilated ligaments and the dissipation of qi and blood from the damaged area, which leads to the deficiency of heart qi and aggravates the deficiency of heart qi. Therefore, the pathological characteristics of postoperative patients are mainly qi deficiency and yang deficiency, and also blood stasis and phlegm, i.e., “the original deficiency is the main, and the evil is real”, coupled with the use of antiplatelet aggregation drugs such as clopidogrel and aspirin after coronary stent implantation, which are TCM drugs that activate blood circulation and remove blood stasis and cold products, undoubtedly aggravate the damage to the right qi, so it is common for patients to have In the hot days, wearing thick cotton clothes, covering multiple layers of quilts, sweating more than a little activity, often accompanied by poor appetite and other symptoms, clinically we use the organic combination of Chinese and Western medicine, from the TCM In clinical practice, we use the organic combination of Chinese and Western medicine, based on the holistic view of Chinese medicine and discriminatory treatment, according to the inherent pathological changes after PCI, combined with the differences in the patient’s endowment and systemic functional status, and drawing on the results of evidence-based medicine and modern pharmacological research, we have determined the treatment principle of “benefitting Qi and invigorating Blood, strengthening the spleen and nourishing the heart”, using Huangqi Sijunzi Tang as the basic formula, and adding the products to invigorate Blood circulation, resolve blood stasis and If the blood stasis is light, we can use Red Peony, Dan Shen, Red Flower, Radix Angelicae Sinensis, Tao Ren and Yu Jin to harmonize the blood, invigorate the blood and move the blood; if the blood stasis is heavy, we can use San Qi, Blood Essence and Turtle Shellac to break the blood and move the blood; if the heart is deficient in Yang, we can add Gui Zhi and Radix et al. The clinical efficacy is remarkable, generally after a course of treatment, the clinical symptoms of patients can be significantly reduced, and long-term observation found that the restenosis rate can be greatly reduced. Therefore, the combined use of Chinese and Western medicine can complement the disadvantages and improve the efficacy.
3. Further improvement of cardiac function
After PCI, the ischemia-related vessels will be recanalized, myocardial tissue will be effectively reperfused, and the surviving myocardium in the infarcted area, stagnant and hibernating myocardium will be saved. The systolic function of these surviving but functionally impaired myocardium will be gradually restored after the ischemic phenomenon is lifted, thus improving local ventricular wall motion, inhibiting ventricular remodeling, and improving the overall systolic function of the left ventricle. The coronary artery that restores blood flow after PCI provides a collateral source for other diseased vessels, all of which can improve LV function. However, reperfusion therapy has created new therapeutic challenges and confusion, such as complications of no-reflow phenomenon, acute thrombosis, restenosis, reperfusion injury, and increased impairment of LV function due to LV remodeling.
In addition, myocardial ischemia is aggravated by the contrast agent, which reduces ventricular compliance; the hyperosmotic effect of the contrast agent, which increases the intravascular fluid volume; and the direct mechanical shock to the myocardium from the high-pressure injection of left ventriculography, which in turn aggravates the functional impairment of the heart. Further development may result in coughing and wheezing, edema, abdominal distension and other dysfunction of the lungs, spleen and kidneys, as well as the combination of phlegm, water and blood stasis. In clinical practice, we make full use of the research results of modern medicine, and on the basis of in-depth understanding of the etiology and pathogenesis of post-PCI cardiac insufficiency, we analyze and discuss theories from both Chinese and Western medicine, identify the evidence, seek the combination point, and guide the use of medicine. We believe that post-operative PCI belongs to the category of “qi deficiency and blood stasis” in Chinese medicine, and the treatment is mainly to benefit qi and activate blood, using Chinese herbal medicines such as princely ginseng, red ginseng or American ginseng, Rhodiola rosea, astragalus, Wujiapi, and yujin for evidence-based treatment, and at the same time, the patient can significantly improve the symptoms with the static injection of raw pulse or ginseng and astragalus fuzheng injection.
Another example: some patients need to receive digitalis chemotherapy, but digitalis toxicity occurs and conduction block occurs. At this time, under the premise of basic identification, the addition of drugs such as Cian Yang Huo, Xian Mao and Panax notoginseng can often lead to improvement of conduction block, prevention and treatment of digitalis toxicity, and reflect a good synergistic effect with western drugs such as digitalis, which has obvious superiority over western drugs alone. In addition, with the prolongation of time, there are numerous patients with coronary artery disease after PCI who have recurrent angina pectoris, decompensated cardiac function, and in some cases even restenosis, while patients without restenosis are considered to be related to coronary microcirculation disorders. The integrity of coronary microcirculation and adequate tissue perfusion are the true criteria for successful reperfusion, and microcirculatory dysfunction has been clinically proven to be an independent predictor of cardiac death and combined events (cardiac death, reinfection, and heart failure). According to TCM, coronary microcirculation disorders should be attributed to damaged heart veins, blood stasis and obstruction, and overall qi and blood, viscera and meridian dysfunction, which can lead to stasis of heart channels. In turn, local blood stasis and damage is a re-pathogenic factor of the overall blood stasis evidence . We can significantly reduce angina attacks and improve the cardiac function of patients with coronary heart disease with chronic heart failure, and reduce the re-hospitalization rate and improve the quality of life, even 1-2 musk pills under the tongue can relieve angina when angina attacks, instead of preferring western nitrate drugs, thus reducing the side effects and drug resistance of western drugs. This reduces side effects and drug resistance.
Modern pharmacological studies have also found that.
① Musk Heart Pill can reduce myocardial ischemia and ischemia-induced intracellular acidosis in patients with coronary heart disease, protect the function of mitochondria, increase the contractility of myocardium, and thus improve cardiac function;
(2) Musk Heart Pill can reduce the release of free radicals and endothelin, protect endothelial function, reduce myocardial cell damage, and promote the recovery of myocardial function.
(3) Muscadine Heart Protective Pill can upregulate the expression of vascular growth factor and its receptor in ischemic myocardial tissue, promote the proliferation of microvascular endothelial cells and the formation of luminal structures, promote angiogenesis, and contribute to the recovery of cardiac function. In conclusion, the combination of Chinese and Western medicine, flexible use of drugs, and the choice of integrated treatment methods of Chinese and Western medicine can achieve better results than simple Chinese or Western medicine treatment.
4.Western and Chinese medicine together “double heart” treatment
Coronary heart disease PCI postoperative with emotional disorders is mainly related to the patient’s susceptibility to quality, mental stimulation and excessive psychological burden, such as not timely and effective control, emotional disorders will gradually aggravate, leading to aggravation of the original disease, increasing the patient’s psychological burden, the emotional disorders more obvious, and ultimately form a vicious circle, seriously affecting the rehabilitation and prognosis of patients with coronary heart disease. In recent years, Professor Hu Dayi, a famous cardiologist, advocated “double heart medicine”, advocating that cardiologists should be “double heart doctors” and establish the concept of treating heart and psychological problems together. At present, the treatment of cardiovascular neurosis of emotional disorders in western medicine is generally under the guidance of doctors using antidepressants and anti-anxiety drugs, and at the same time help patients to establish a regular life and reduce psychological stress, to maintain a good state of mind. However, the cardiotoxicity, hepatic and renal toxicities, drug-drug interactions, and high prices of western antidepressants make patients less adherent to treatment. Chinese medicine traditionally takes the mind and body as one, and its “theory of unity of form and spirit” is the basis of the theory of emotion and will.
According to TCM, the heart is the master of the mind, and the human spirit, consciousness and thinking activities are related to the heart. At the same time, external stimuli can also cause changes in internal emotions, or directly injure the internal organs, with the heart, liver and spleen being the most common ones, causing disorders of qi flow, resulting in disorders of qi and blood flow, and eventually physical symptoms, or aggravating the existing physical symptoms. Clinically, we can identify and implement the use of Chai Hu, Yu Jin, Ziziphiopogon, Mu Xiang, Chuanxiong and other Chinese herbs to regulate the liver and qi, calm the mind and brain, and strengthen the spleen and stomach, which can significantly improve the symptoms of mood disorders in patients with coronary heart disease, without the side effects of western drugs such as liver and kidney toxicity, especially the recovery of patients after PCI plays a beneficial synergistic therapeutic role.
5. Health education and evidence-based nutrition.
Health education is a powerful measure to promote the rehabilitation of coronary heart disease and improve the health level of patients with coronary heart disease. Its purpose is to make patients understand the knowledge of health promotion and eventually establish healthy behavior. In the best physical and mental state of treatment, reduce the recurrence rate and death rate of coronary heart disease, and improve the quality of life of coronary heart disease patients. Western medicine generally provides health education to patients with coronary heart disease in the form of single instruction and group education on basic knowledge, diet, exercise, psychology and medication. In contrast, Chinese medicine also focuses on food therapy to nourish the body and soul on this basis. We treat patients with coronary heart disease with the principle of dialectical treatment, and according to individual differences, we use different therapeutic dietary prescriptions to complement the treatment.
In principle, it is advisable to be light, avoid thick and greasy, eat more fish, avoid eating animal offal, and eat more vegetables and fruits, such as phlegm and stagnation type to give mushroom and peach kernel soup (mushroom, peach kernel), qi and yin deficiency type to give ginseng and winter porridge (ginseng, maitake), heart qi deficiency type to give ginseng and astragalus and wu chicken soup (ginseng, astragalus, wu chicken), heart yin deficiency type to give Zhi Mu Bai He thin rice (Zhi Mu, lily), etc., and different therapeutic meals are given according to the combination of different diseases. The food therapy medicine meal is given according to the combination of different diseases, such as hawthorn and chrysanthemum tea drink for hypertension, hawthorn and lotus leaf porridge for the combination of hyperlipidemia, and kudzu and winter melon soup for the combination of diabetes. Through health education and therapeutic diet, the patients have significantly changed and improved their knowledge about coronary heart disease, changed their poor lifestyles and unreasonable diets, improved their awareness of self-care, and mobilized their enthusiasm to cooperate with the treatment, which has a great effect on improving prognosis, reducing complications, prolonging life expectancy and improving the quality of life of patients with coronary heart disease.