ObjectiveTo compare the clinical effectiveness of Chinese medicine with that of integrated Chinese medicine and antimicrobial drugs in the treatment of pneumonia. MethodsThe electronic medical record (EMR) of patients with pneumonia who were admitted to the Classical Department of Chinese Medicine of Guangdong Hospital of Traditional Chinese Medicine from November 29, 2012 to June 17, 2022 were retrospectively collected. The patients were divided into two groups according to whether they were treated with antimicrobial drugs on the basis of Chinese medicine treatment. The non-exposed group was the traditional Chinese medicine group, and the exposed group was the integrated Chinese medicine and antimicrobial drugs group. Propensity score matching method was used to balance possible confounding factors. COX regression analysis was performed on the matched cohort to compare death rates among the groups, and Kaplan-Meier curve was drawn to evaluate the survival probability during hospitalization. The proportion of maximum oxygen concentration and duration of fever remission were compared between the two groups. ResultsThis study included a total of 898 cases, with the majority (over 95%) falling within the range of mild to moderate severity. After propensity score matching,180 patients remained in each group, among whom the baseline characteristics were comparable. The primary outcome indicators showed that the risk of death during hospitalization was same in the integrated Chinese medicine and antimicrobial drugs group and in the Chinese medicine group (HR=1.52, 95%CI 0.36 to 6.39, P=0.566), the subgroup analysis was consistent with the overall trend of the results, and the differences were not statistically significant. The results indicate that during the hospitalization, the overall and subgroup mortality rates were similar between the two groups. The treatment effectiveness on the disappearance of major symptoms such as fever, cough, sputum production, fatigue, shortness of breath, and chest pain were comparable in both groups. The secondary outcome indicators showed that there was no statistical significance in the comparison of the proportion of maximum oxygen therapy concentration and the stable duration of fever remission between the two groups. ConclusionIn the treatment of patients with mainly mild to moderate pneumonia, the effectiveness of the Chinese medicine group and the integrated Chinese medicine and antimicrobial drugs group in the hospitalization mortality, the disappearance of major symptoms, the proportion of maximum oxygen therapy concentration and the stable duration of fever remission are similar. Chinese medicine has a positive significance in reducing the use of antimicrobials in patients with pneumonia.
Clinical practice guidelines need to be based on evidence, but traditional Chinese medicine, especially integration of traditional Chinese and Western medicine guidelines, inevitably need to combine clinical research evidence, ancient literature, and expert experience and consensus. In the process of formulating, there are deviations in understanding and application of the expert consensus method and expert experience, resulting in opaque of the recommendations, unclear of the details of the diagnosis and treatment strategy, less prominent of the advantages and value of traditional Chinese medicine, which affects the scientificity, transparency, applicability, promotion and application of the guidelines of traditional Chinese medicine or integration of traditional Chinese and Western medicine. This study discusses the guiding principle of "evidence as a core, consensus as a supplement, and experience as a reference" that was generally followed and puts forward detailed methodological suggestions to the formulation of guidelines for traditional Chinese medicine and integration of traditional Chinese and Western medicine.
Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
目的:观察中西医结合综合治疗重症急性胆源性胰腺炎(SABP)的效果。方法:回顾性分析四川大学华西医院2004年1月至2007年8月收治的85例SABP患者在给予禁食、胃肠减压、补液、预防及治疗感染、维持内环境、营养支持、抑制胃肠和胰液的分泌治疗的基础上给予中药柴芩承气汤经口入或保留灌肠导泻,观察这些患者的治疗效果。结果:85例SABP患者经过中西医结合内科保守治疗后58名痊愈,14例患者症状缓解出院。5例患者死亡,8例患者治疗无效,无效率为15.3%,死亡率为5.9%。结论:中西医结合方法治疗SABP患者可明显提高治疗效果及降低死亡率。
Acute pancreatitis is a common surgical acute abdomen in clinical practice. With the development of minimally invasive technology, more and more treatment methods are being applied to acute pancreatitis, especially for severe acute pancreatitis and acute biliary pancreatitis. At present, the efficacy of integrated traditional Chinese and Western medicine in the treatment of acute pancreatitis has been widely recognized. In terms of minimally invasive diagnosis and treatment of acute pancreatitis, the “SELECT” concept of integrated traditional Chinese and Western medicine minimally invasive diagnosis and treatment has emerged. Based on the severity and etiology of acute pancreatitis, the optimal combination of multiple endoscope (Spyglass, encoscopic retrograde cholangiopancreatography, laparoscopy, endoscopic ultrasound, choledochoscopy) is selected, and combined with traditional Chinese medicine treatment. With a patient-centered approach, we have achieved minimally invasive, individualized, and precise treatment of acute pancreatitis through the integration of traditional Chinese and Western medicine.
Integrated traditional Chinese and Western medicine has been used to treat acute pancreatitis (AP) for more than 50 years. It has become a dominant and specialized disease treated by integrated traditional Chinese and Western medicine. After many years of clinical practice, a relatively mature and complete treatment system has been formed. Therefore, it was proposed by the Chinese Society of Integrated Traditional Chinese and Western Medicine, the Chinese Medical Association, and the Chinese Association of Traditional Chinese Medicine to update and formulate the “Guidelines for the Diagnosis and Treatment of Acute Pancreatitis with Integrated Traditional Chinese and Western Medicine” (2021) group standards in 2022, and “Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis” finally published. The guideline condenses 25 kinds of important clinical issues, which guide to explain the diagnosis and treatment of AP in detail, focusing on the integration of traditional Chinese medicine and Western medicine in the management of AP, such as staging and syndrome differentiation, early fluid therapy, pain management, and organ function support in early stage. The advantages and the timing of early intervention of traditional Chinese medicine in AP are emphasized. This guideline also proposes suggestions on nutritional support, management of causes, treatment of late local complications and infections, as well as prevention of recurrence and follow-up strategies for long-term complications. This paper provides an interpretation of this guideline.
Objective To evaluate the clinical efficacy and safety of TanReqing Injection in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD), and to observe its effects on the plasma levels of cytokine IL-17, IL- 8 and Leukotriene B4 in such cases. Methods A randomized, single blind controlled trial (RCT) was designed. Sixty hospitalized COPD patients with an acute exacerbation were randomly allocated to the treatment group (20 ml of TanReqing Injection iv gtt q 24 h) or the control group (20 ml of placebo Injection iv gtt q 24 h) based on the Guideline for Dignosis and Management of COPD issued by Chinese Society for Respiratory Disease and the Criteria of Dignosis and Efficacy Measures of Traditional Chinese Medicine Syndrome and Illness enacted by The State Administration of Traditional Chinese Medicine. All patients were received standard therapy. Each group contained 30 patients. The therapeutic course of both groups was 12 days. The criterias of TCM syndrome of retention of phlegm-heat in the lung were: cough with rough breath, accumulation of sticky or yellow thick sputum, cough with difficulty in expectoration, or accompanied by fever, thirst with desire of drink, red tougue with yellow fur, slippery and rapid pulse. Results According to the analysis on the basis of intention -to -treat and per-protocol population, it showed that the markedly effective rates were 70.00% and 72.41% respectively, and effective rates were 96.67% and 96.55% in the treatment group respectively. While in the control group the markedly effectiverates were 46.67% and 48.28% respectively, and effective rates were 86.67% and 89.65% respectively. Significantly lower plasma concentration of IL-17 and IL-8 in the treatment group was noted when compared with control group. There was a statistically significant difference between two groups (Plt;0.05). Conclusions TanReqing Injection shows a definite clinical effectiveness without obvious toxic-adverse effects in the treatment of patients with acute exacerbations of COPD and its mechnical function may related to the level of the excess expression of plasma cytokine IL-17, IL-8 in such cases.