Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

A Chinese Multi-Specialty Delphi Consensus to Optimize RAASi Usage and Hyperkalaemia Management in Patients with Chronic Kidney Disease and Heart Failure

Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldosterone system inhibitors(RAASi)usage and HK management in patients with chronic kidney disease(CKD)&heart failure(HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.Methods A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique.The group then created a list of 41 statements for a consensus questionnaire,which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China.Consensus was assessed using a modified Delphi technique,with agreement defined as"strong"(≥75%and<90%)and"very strong"(≥90%).The steering group,data collection,and analysis were aided by an independent facilitator.Results A total of 150 responses from 21 provinces across China were recruited in the survey.Respondents were comprised of an even split(n=75,50%)between cardiologists and nephrologists.All 41 statements achieved the 75%consensus agreement threshold,of which 27 statements attained very strong consensus(≥90%agreement)and 14 attained strong consensus(agreement between 75%and 90%).Conclusion Based on the agreement levels from respondents,the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.

Pattern of disharmony between the heart and kidney: Theoretical basis, identification and treatment

'Harmony between the heart and kidney' refers to the physiological relationship between these two zang organs in Chinese medicine,while 'disharmony between the heart and kidney' (also called disharmony between fire and water) refers to the pathological state.The pattern of disharmony between the heart and kidney is widely observed in patients with insomnia,anxiety disorder and menopausal syndrome,etc..In order to gain a full and systematical understanding of this pattern,from the perspective of ancient Chinese philosophy and zang-fu theory in Chinese medicine,we systematically reviewed and discussed the functions and physiological characteristics of the heart and kidney,the origin and development of theories relating to heart-kidney relationship,the pathogenesis and identification of the pattern,as well as the commonly used classical formulas for its treatment,including Coptis and DonkeyHide Gelatin Decoction (Huánglián (E)jiāo Tāng) and Grand Communication Pill (Jiāotài Wán).Two examples of clinical modifications of these formulas in the treatment of insomnia and menopausal syndrome are provided in this article.It should be noted that in clinical practice,these formulas should be used flexibly,and modified in accordance to the condition of the patient.

Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease

Atrial fibrillation(AF) is the most common type of sustained arrhythmia,which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of our article is to determine the prognostic impact of AF on acute coronary syndromes,heart failure and chronic kidney disease. Multiple studies have been conducted to determine if AF has an independent role in the overall mortality of such patients. Our review suggests that AF has an independent adverse prognostic impact on the clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease.

Prognostic Factors in Cardiorenal Syndrome Type 1: Retrospective Observational and Analytical Study

Introduction: Type 1 cardiorenal syndrome (CRS 1) is characterized by acute impairment of cardiac function leading to acute renal dysfunction. CRS1 is present in 25% of patients admitted for heart failure. The objective of our study is to analyze the epidemiological, clinical, therapeutic profile and the risk and prognostic factors of these patients. Materials and Methods: We identified 120 patients with cardiorenal syndrome (CRS) over a one-year period to determine the prevalence and risk factors for developing CRS 1. We analyzed the clinical, biological, and evolutionary profiles of patients with CRS 1 and determined the risk factors for the occurrence of acute kidney injury (AKI) as well as the mortality factors in these patients. Résultats: The average age of our patients with CRS1 is 58 ± 9 years, with a sex ratio of 1.4. The average eGFR of our patients is 35 ± 6.5 ml/min/1.73m2. Diabetes was found in 17% of our patients and hypertension in 14%. The etiology of cardiac impairment is predominantly acute coronary syndrome (ACS), followed by rhythm disorders. Renally, all our patients have acute kidney injury (AKI), with 86% having functional acute renal failure and 14% having acute tubular necrosis. Therapeutically, 50% of our patients are on diuretics, 42% receive beta-blocker treatment, and RAAS blockers are used in 29% of cases. Renal replacement therapy (RRT) sessions were required in 13.8% of cases. In univariate analysis, male gender, tachyarrhythmia, and hypertension are associated with the early onset of acute kidney injury (AKI). The use of diuretics, anemia, and low left ventricular ejection fraction (LVEF) are linked to a higher risk of developing CRS 1 (p = 0.021, p = 0.037, p = 0.010 respectively). In multivariate analysis, advanced age is significantly associated with increased mortality risk in CRS 1 patients (p = 0.030), while beta-blocker use is considered a protective factor (p = 0.014). Conclusion: Our study identifies several key factors associated with outcomes in type 1 CRS. Male gender, tachyarrhythmia, and hypertension are linked to early-onset AKI. The use of diuretics and the presence of anemia increase the risk of developing CRS1. Advanced age is significantly associated with higher mortality rates. Conversely, the use of beta-blockers appears to be protective in this patient population. .

Range of adiposity and cardiorenal syndrome

Obesity and obesity-related co-morbidities,diabetes mellitus,and hypertension are among the fastest-growing risk factors of heart failure and kidney disease worldwide.Obesity,which is not a unitary concept,or a static process,ranges from alterations in distribution to the amount of adiposity.Visceral adiposity,which includes intraabdominal visceral fat mass and ectopic fat deposition such as hepatic,cardiac,or renal,was robustly associated with a greater risk for cardiorenal morbidity than subcutaneous adiposity.In addition,morbid obesity has also demonstrated a negative effect on cardiac and renal functioning.The mechanisms by which adipose tissue is linked with the cardiorenal syndrome(CRS)are hemodynamic and mechanical changes,as well neurohumoral pathways such as insulin resistance,endothelial dysfunction,nitric oxide bioavailability,renin-angiotensin-aldosterone,oxidative stress,sympathetic nervous systems,natriuretic peptides,adipokines and inflammation.Adiposity and other associated co-morbidities induce adverse cardiac remodeling and interstitial fibrosis.Heart failure with preserved ejection fraction has been associated with obesity-related functional and structural abnormalities.Obesity might also impair kidney function through hyperfiltration,increased glomerular capillary wall tension,and podocyte dysfunction,which leads to tubulointerstitial fibrosis and loss of nephrons and,finally,chronic kidney disease.The development of new treatments with renal and cardiac effects in the context of type 2 diabetes,which improves mortality outcome,has highlighted the importance of CRS and its prevalence.Increased body fat triggers cellular,neurohumoral and metabolic pathways,which create a phenotype of the CRS with specific cellular and biochemical biomarkers.Obesity has become a single cardiorenal umbrella or type of cardiorenal metabolic syndrome.This review article provides a clinical overview of the available data on the relationship between a range of adiposity and CRS,the support for obesity as a single cardiorenal umbrella,and the most relevant studies on the recent therapeutic approaches.

Role of imaging in the evaluation of renal dysfunction in heart failure patients

Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction,known as cardiorenal syndrome.In heart failure patients,renal impairment is related to hemodynamic and nonhemodynamic factors.Both decreased renal blood flow and renal venous congestion due to heart failure could lead to impaired renal function.Kidney disease and worsening renal function are independently associated with poor prognosis in heart failure patients,both in acute and chronic clinical settings.The aim of this review is to assess the role of renal imaging modalities in the evaluation and management of heart failure patients.Renal imaging techniques could complete laboratory data,as estimated glomerular filtration rate,exploring different pathophysiological factors involved in kidney disease and adding valuable information about renal structure and function.In particular,Doppler examination of arterial and venous hemodynamics is a feasible and non invasive technique,which has proven to be a reliable method for prognostic stratification in patients with cardiorenal syndrome.The renal resistance index,a measure related to renal hemodynamics,can be calculated from the Doppler evaluation of arterial flow.Moreover,the analysis of Doppler venous flow patterns can integrate information from the arterial study and evaluate renal congestion.Other imaging modalities are promising,but still confined to research purposes.

Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction

Myocardial infarction(MI)is defined as myocardial cell death due to prolonged myocardial ischemia.Clinically,troponin rise and/or fall have become the“defining feature of MI”according to the universal definition of MI(UD-MI).Takotsubo syndrome(TS)and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia.By strict application of the clinical diagnostic criteria for type-1 MI,type-2 MI,type-3 MI,and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently,TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI.The existing evidence argues for the case that TS by itself is not a MI.Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS.This autonomic neuro-cardiogenic(ANCA)mechanism results in myocardial“cramp”(stunning),the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover.The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions.This ANCA syndrome,which has hitherto been enveloped by the UD-MI over more than one decade,may occur in acute,recurrent,and chronic forms.In this critical review,the controversies of UD-MI,evidence for ANCA syndrome,and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided.

Evidence based review of management of cardiorenal syndrome type 1

Cardiorenal syndrome(CRS)type 1 is the development of acute kidney injury in patients with acute decompensated heart failure.CRS often results in prolonged hospitalization,a higher rate of rehospitalization,high morbidity,and high mortality.The pathophysiology of CRS is complex and involves hemodynamic changes,neurohormonal activation,hypothalamic-pituitary stress reaction,inflammation,and infection.However,there is limited evidence or guideline in managing CRS type 1,and the established therapeutic strategies mainly target the symptomatic relief of heart failure.This review will discuss the strategies in the management of CRS type 1.Six clinical studies have been included in this review that include different treatment strategies such as nesiritide,dopamine,levosimendan,tolvaptan,dobutamine,and ultrafiltration.Treatment strategies for CRS type 1 are derived based on the current literature.Early recognition and treatment of CRS can improve the outcomes of the patients significantly.

黄连阿胶汤治疗围绝经期失眠的研究进展

随着现代社会的进步,女性家庭、工作、社会等多方面的压力增加,导致其围绝经期失眠的发病率逐渐增加,影响其生活质量。所以如何有效地治疗围绝经期失眠已成为当前社会的研究热点。西医临床以激素和镇静催眠类药物治疗为主,虽可取得一定的效果,但易出现较多不良反应。另外,长期使用激素和镇静催眠类药物可使人的记忆力减退,反应能力下降。中医治疗围绝经期失眠注重整体调理,辨证论治,效果显著,安全性高。中医认为,肾虚是围绝经期女性的主要生理特点,是导致女性失眠的重要病理依据,肾阴亏虚、心火亢盛、阴虚阳扰、心肾不交为其病因。黄连阿胶汤为治疗心肾不交型围绝经期失眠的常用方剂,不仅可以缓解症状,还能够改善睡眠质量以及调节内分泌系统。为此,文章综合众多的文献,研究黄连阿胶汤治疗围绝经期失眠的临床效果,分析其治疗价值,以期为临床应用提供参考依据。

王秀娟运用和法论治手汗症经验

王秀娟教授认为,手汗症病机多与局部郁热蕴蒸、经络瘀滞不通有关,主要辨证分型为:肺脾不和证、中焦郁热证与心神失养证。王教授擅长运用和法,从脾胃治疗手汗症,手心汗出过多的肺脾不和证,常运用和脾胃、健脾气或补脾益肺为法,以复肺气之宣肃;中焦郁热证,常用和肝运脾之法,以疏肝泻火、健脾运浊;心神失养证,在补益心脾的基础上侧重健脾益气,中气和则五脏调。王教授治疗手汗症,注重整体辨证,阴阳表里寒热并重,重视中焦气机失调之病机,同时关注情志因素,遵循李东垣“内伤劳役伤脾气,饮食伤胃伤其形”之脾胃观,不忘将现代社会压力下人们的身心疾病因素考虑在内。在用药方面,王教授注重整体观,遣方用药以和为主,重在调和气机,辨证运用和肝疏郁、调和营卫、和解少阳等治法,使机体达到阴平阳秘之稳态。

董氏奇穴埋线联合耳尖放血治疗心肾不交型围绝经期综合征伴失眠的疗效观察

目的观察董氏奇穴埋线联合耳尖放血治疗心肾不交型围绝经期综合征伴失眠的临床疗效。方法选择207例心肾不交型围绝经期综合征伴失眠的患者,脱落20例,最终纳入患者187例,用区组化随机分组的方法分为对照组(57例)、针刺组(65例)和埋线组(65例)。对照组予口服坤泰胶囊治疗,针刺组予普通针刺董氏奇穴联合耳尖放血治疗,埋线组予董氏奇穴埋线联合耳尖放血治疗。比较3组临床疗效、复发情况和不良反应发生情况,观察3组治疗前后匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分、中医证候积分、围绝经期症状评分以及血清睡眠相关因子及激素[卵泡刺激素(follicle-stimulating hormone,FSH)、雌二醇(estradiol,E2)、促黄体生成素(luteinizing hormone,LH)、5-羟色胺(5-hydroxytryptamine,5-HT)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、胶质源性神经营养因子(glial cell linederived neurotrophic factor,GDNF)]水平的变化。结果埋线组总有效率高于其余两组(P<0.05),复发率低于其余两组(P<0.05);3组不良反应发生率比较,差异无统计学意义(P>0.05)。治疗后,3组PSQI评分均较治疗前降低(P<0.05);埋线组PSQI的睡眠质量、入睡时间、睡眠时间、睡眠障碍和日间功能障碍评分及总分均低于对照组(P<0.05);埋线组PSQI的睡眠时间和睡眠效率评分及总分低于针刺组(P<0.05)。治疗后,3组中医证候积分均较治疗前降低(P<0.05);埋线组中医证候积分低于针刺组和对照组,差异均具有统计学意义(P<0.05)。治疗后,3组围绝经期症状评分均较治疗前降低(P<0.05);埋线组和针刺组围绝经期症状评分均低于对照组(P<0.05)。治疗后,3组血清E2、5-HT、BDNF和GDNF水平较治疗前升高(P<0.05);埋线组血清5-HT、BDNF和GDNF水平高于对照组(P<0.05),血清5-HT水平高于针刺组(P<0.05)。结论董氏奇穴埋线联合耳尖放血治疗心肾不交型围绝经期综合征伴失眠的疗效优于口服中成药和针刺治疗,可改善临床症状和睡眠质量,降低复发,可能与提高5-HT、BDNF和GDNF水平有关。

火龙罐对心肾不交型围绝经期患者睡眠状况的影响

目的 观察火龙罐疗法对心肾不交型围绝经期患者睡眠状况的影响。方法 将已确诊并符合纳入标准的102例心肾不交型围绝经期患者按照1∶1分组,其中对照组给予传统疗法,研究组实施火龙罐疗法,1个月后运用统计学原理对2组睡眠状况的指标进行对比分析。结果 研究组睡眠质量改善有效率高于对照组,差异有统计学意义(P<0.05)。2组治疗后PSQI各项评分(睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍及日间功能障碍)均下降,且差异有统计学意义(P<0.05),其中研究组分值均低于对照组,差异有统计学意义(P<0.05)。结论 心肾不交型围绝经期患者应用火龙罐治疗能有效提升自身睡眠质量,值得进一步推广。

中医药治疗围绝经期女性心悸研究概况

通过综述近年来中医药治疗围绝经期女性心悸的研究情况,发现围绝经期女性心悸发病与雌激素水平波动有关,病机为阴阳气血失和、脏腑功能失调,病位在心,与肾、肝、脾关系密切,常见证型包括阴虚火旺证、心肾阳虚证、气阴两虚证、肝脾不调证、肝郁气滞证。本病治疗多针对病机,辨证论治,通过滋阴降火、温补肾阳、益气养阴、疏肝健脾、疏肝理气以调整阴阳气血,促进机体恢复动态平衡。参考文献33篇。

论陈士铎辨治耳鸣病症思想探讨

清代医家陈士铎对耳鸣病症见解独到,他认为耳鸣的病因有心肾不交、胆气不舒致风火侵袭、肝胆气郁、肝血虚损及阳虚。根据阴阳、气血相互转化、脏腑相关关系,结合耳鸣的病因病机,提出交通心肾、舒发肝胆、疏肝健脾、补益气血、补阳滋阴等治疗方法,自拟两归汤、润胆汤、开郁至神汤、缓中汤、发阳通阴汤等方药,组方用药层层深入,方药精湛。根据相关医案可知,陈士铎诊治耳鸣病症的思维依然运用在当代临床实践中。

基于俞募配穴法探讨不同剂量隔姜灸治疗心肾不交型不寐临床观察

目的观察不同灸量隔姜灸治疗心肾不交型不寐的临床效果。方法将90例患者按简单随机方法分为2壮组(A组)、4壮组(B组)、6壮组(C组),使用“俞募配穴”法,取心俞、肾俞、京门、大敦、巨阙、关元。均予每日1次隔姜灸,连续6次为1疗程,持续2个疗程。观察3组治疗前及2个疗程后匹兹堡睡眠质量指数量表(PSQI)、中医症状量表评分及不良反应和临床效果。结果观察过程中3组共脱落5例,最终纳入病例85例。A组总有效率62.1%(18/29)明显低于B组的93.1%(27/29)、C组的96.3%(26/27)(P<0.05),B组与C组比较,差异无统计学意义(P>0.05)。治疗后,B组PSQI总积分及睡眠质量、入睡时间、催眠药物使用评分低于A、C组(P<0.05)。治疗过程中不良反应发生情况为A组未出现、B组1例、C组10例。结论隔姜灸可有效改善心肾不交型不寐,4壮组较2壮组和6壮组更安全有效。

护卵汤对围绝经期综合征心肾不交型患者的疗效观察与作用机制研究

目的探讨护卵汤对心肾不交型围绝经期综合征患者性激素水平、Kupperman评分及骨密度水平的影响。方法选择2016年3月至2017年4月80例心肾不交型围绝经期综合征患者进行研究。采用随机数字表法将患者分为2组,每组40例。对照组给予替勃龙片,观察组在此基础上加以护卵汤。比较两组患者临床疗效、性激素水平、Kupperman评分、骨密度水平及安全性指标。结果观察组患者总有效率为90.0%,显著高于对照组的67.5%;治疗后两组患者FSH、LH水平及Kupperman评分均明显下降,但观察组下降幅度更大(P<0.05);治疗后两组患者E2、腰椎1-4节及左股骨骨密度水平均明显升高,但观察组升高更明显(P<0.05)。对照组出现2例(5.0%)不良反应,与观察组的1例(2.5%)差异无统计学意义(P>0.05)。结论护卵汤联合替勃龙较单独使用替勃龙可明显提高心肾不交型围绝经期综合征疗效,改善性激素和骨密度水平,降低Kupperman评分,且具有较高的安全性。

欢乐宁方治疗心肾不交型围绝经期综合征36例临床观察

目的:观察欢乐宁方治疗心肾不交型围绝经期综合征的临床疗效及安全性。方法:对符合心肾不交型围绝经期综合征的患者进行为期3个月的治疗,采用Kupperman改良记分法,比较治疗前后各症状改善情况。结果:纳入病例36例,治疗前后各项症状(除性交痛外)Kupperman评分比较及治疗前后总积分比较,差异均有显著性意义(P<0.05)。临床总有效率97.22%。不良反应发生很少,治疗前后血常规、肝肾功能、心电图等均未见异常。结论:欢乐宁方治疗心肾不交型围绝经期综合征疗效可靠,临床安全性高。

心肾综合征中医研究近况

心肾综合征(CRS)临床常见,该病归属于中医"水气病"、"心悸"、"喘促"等范畴。其病因病机为少阴阳虚导致的心肾失交,辨证分型多样。目前用5/6肾切除或左冠状动脉前降支结扎联合缩窄升主动脉再灌注,服寒凉药或甲状腺切除联用阿霉素注射等方法制作CRS动物模型及病证结合模型。在治疗上,如果以"心肾相交、心肾同治"为理论指导,以温阳活血、调理脾胃为治法,对于研究CRS具有重要意义。

穴位埋线联合心理疗法治疗更年期心肾不交型失眠症43例

目的观察穴位埋线联合心理疗法治疗更年期心肾不交型失眠症的临床效果。方法对43例更年期心肾不交型失眠症患者采用穴位埋线联合认知治疗、行为矫正治疗等心理疗法治疗,统计分析治疗效果。结果 43例患者临床痊愈19例,占44.2%;显效13例,占30.2%;有效9例,占20.9%;无效2例,占4.7%。总有效率为95.3%。治疗前后血清E2水平经统计学处理比较,差异有统计学意义(P<0.01)。结论穴位埋线联合心理疗法治疗更年期心肾不交型失眠症具有较好疗效,可升高血清E2水平,提高雌激素分泌,增强卵巢功能。