Correlative Factors Analysis Of Affect The Prognosis Of Malignant Middle Cerebral Infarction And The Study Of TCM Syndrome Distribution Regularity

BackgroundPatients with malignant middle cerebral infarction have a mortality rate as high as from 53 to 89 percent even though they are treated by active conservative treatment within 5 days, and survival in patients with more than 80 percent left with severe disability. It has a high high mortality rate、 high disability rate、poor prognosis, which brings a heavy blow and burden to the family members of patients and society, therefore actively seeking factors associated with prognosis in order to make the best clinical treatment strategies so as to improve the prognosis of patients is very important. Study on the TCM syndrome distribution regularity of malignant middle cerebral infarction in acute stage and its relationship with prognosis is less, it is necessary to further explore. Combine traditional Chinese and western medicine treatment so as to better improve the clinical curative effect.ObjectiveAnalysis related factors which influence the early outcome and short-term prognosis of acute malignant MCA infarction. Study on the different TCM syndrome of malignant middle cerebral infarction in acute stage and its relationship with prognosis, which guide to establish the therapy program combined traditional Chinese medicine and Western medicine to improve clinical effects.MethodsRetrospectively analyze the clinical data of patients attacked malignant MCA infarction who were admitted to Neural Department one and Neural Department three of Guangdong hospital of TCM from October 2009 to October 2014. The clinical data includes gender, age, smoking, medical history, onset time, hospit- alization time, discharge time, the time of death, vital signs on admission to hospital,NIHSS score on admission to hospital, GCS score, mRS score, clinical manifestations, imaging findings, laboratory test, therapeutic schedule, hospitalization complications, TCM syndrome types, the 30-day mortality, the 90-day mRS score, etc. The 30-day mortality is the evaluation index of early outcome and the 90-day mRS score is the evaluation index of short-term prognosis. Statistical analysis the correlation between the above factors and prognosis.ResultsThis study included 79 patients, on the onset of 30 days 21 cases died (26.6%),58 cases survival(73.4%). on the onset of 90 days, the number of patients with good prognosis (mRS score of 4 or less) is 46(57.5%) and the number of poor prognosis (mRS score>4)is 33(42.5%). (1)the single factor analysis results, GCS score on admission, NIHSS score, midline shift 10mm or higher, complications (cerebral hernia, pulmonary infection, acute heart failure, acute myocardial infarction)may be the risk factors which affect the 30-day mortality;NIHSS score on admission, GCS score, cerebral hernia, acute heart failure may be the risk factors for the short-term poor prognosis. (2)the multi-factor analysis results, GCS score on admission and NIHSS score are the important factors influencing the early adverse outcome, the lower the GCS score, the higher 30-day mortality (HR=0.61,95%CI:0.49-0.76, P<0.001), the higher the NIHSS score, the higher the 30-day mortality(HR=1.3,95%CI:1.1-1.4, P<0.001);GCS score on admission, NIHSS score and midline shift 10mm are the influence factor of short-term adverse prognosis(mRS score 5 points or more). the lower the GCS score on admission, the worse the short-term nervous function prognosis(OR=0.54,95%CI:0.37-0.78, P=0.001), the higher the NIHSS score on admission, the worse the short-term nerve function prognosis (OR=1.5, 95%CI:1.2-1.9, P<0.001),midline shift 10mm or more influence the poor short-term prognosis(OR=13.7,95%CI:1.1-163.1, P=0.038).On admission TCM syndrome distribution is,endogenous wind syndrome 49 cases(62.0%), endogenous fire syndrome 18 cases(17.6%), phlegm dampness syndrome 68 cases(86.1%), blood stasis syndrome 51 cases(64.6%), qi deficiency 48 cases(60.8%), Yin deficiency 4 cases(5.1%). On the acute phase of Malignant MCA infarction, different TCM syndrome elements had no statistical significance to the early outcome or short-term neural functional prognosis(P>0.05).ConclusionThe mortality and morbidity Of Malignant MCA infarction are high, GCS score and NIHSS score on admission are important factors of affecting the 30-day mortality, the lower the GCS score and the higher the NIHSS score, the higher the 30-day mortality rate, GCS score on admission, NIHSS score and degree of midline shift affect short-term prognosis, the lower the GCS score, the higher the NIHSS score, midline shift 10mm or more, the poorer the 90-day nervous function recovery. On the acute phase of malignant MCA infarction, different TCM syndrome factor are not related with the early outcome and short-term prognosis.