Preliminary implementation and effect of clinical pathways for chronic Keshan disease in endemic areas / 中国地方病学杂志

ABSTRACT

Objective This present study explores and evaluates the effect of preliminary implementation in the clinical therapy programs for patients with chronic Keshan disease (CKD) in the disease seriously-affected endemic areas.Methods In 2010,seventy-six CKD patients with heart failure were chosen from Huangling and Xunyi Counties in Shaanxi Province,where incidences of CKD were high.Besides taking sodium selenite,all patients were given treatment with fixed prescription,which included angiotensin-converting enzyme inhibitor (captopril),β-blocker (propranolol),diuretics (hydrochlorothiazide,spironolactone) and cardiac (digoxin) for 4 months.The changes before and after treatment were analyzed,which included the changes of heart function by the United States of America New York Heart Association(NYHA) fractionation,cardiothoracic ratio,electrocardiogram,left ventricular ejection fraction(EF) and fractional shortening(FS).The therapeutic effect was subsequently evaluated.Results Seventy-four cases of the seventy-six CKD patients completed the treatment observation.The improvement rate of heart function was 81.1％ (60/74) after treatment.The elimination rates of ectopic rhythm,conduction block and ST-T changes were 37.5％ (9/24),2.7％ (1/36) and 26.9％ (7/26),respectively.The cardiothoracic ratios of heart function NYHA Ⅱ,Ⅲ and Ⅳ were 0.504 ± 0.051,0.572 ± 0.054 and 0.632 ± 0.063 before treatment.After treatment,the cardiothoracic ratios were 0.486 ± 0.048,0.538 ± 0.046 and 0.607 ± 0.048,which were reduced in all groups (t =2.643,6.641,3.005,all P ＜ 0.05),while the D-value of cardiothoracic ratio changes before and after treatment was not significantly different(F =3.005,P ＞ 0.05).Both the mild reduction group(35％≤EF ＜ 50％) and the moderate-severe group(EF ＜ 35％) EF were (43.62 ± 4.58)％,(27.57 ± 3.69)％ before treatment and were (48.21 ± 10.01)％,(36.57 ± 6.60)％ after treatment,EF were increased in the two groups,while the changes before and after treatment were significantly different(t =-2.911,-3.334,all P＜ 0.05).The EF D-value of the two groups was (4.59 ± 8.48)％ before treatment and was (9.00 ± 7.14)％ after treatment,which were not significantly different(P ＞ 0.05).FS was higher compared with pre-treatment in FS reduction group(FS ＜ 25％) and the changes before and after treatment[(19.75 ± 2.88)％,(21.92 ± 5.67)％] were significantly different(t =-2.297,P ＜ 0.05).Conclusions This study shows that the feasibility of clinical treatment of patients with CKD is very promising.The treatment of fixed prescription is effective.