Correlative Research On The Deterioration Of Neurological Function In The Early Stage Of Acute Watershed Cerebral Infarction And TCM Treatment

Objective:To determine the high risk factors of early neurological deterioration(END)in patients with acute watershed infarction(CWI)from the following aspects:pathological pattern(clinical case classification),basic factors,clinical factors,auxiliary examinations and three large scale baseline scores.According to these factors,we try to build a relatively complete,scientific and reasonable clinical early warning mechanism to better serve the clinical work.Methods:106 patients with watershed cerebral infarction were enrolled in Department of Neurology,Taixing Hospital Affiliated to Yangzhou University from January 2014 to December 2017.All patients were strictly screened according to the relevant guidelines and diagnostic criteria.According to the imaging results,patients were divided into two groups:subcortical,internal watershed infarction(IWSI)and extermal watershed infarction(also known as cortical,External watershed infarction or Cortex watershed infarction,EWSI or CWSI).After admission,all patients were scored by Glasgow Coma Score(GCS),National Institutes of Health Stroke Scale(NIHSS)and modified RANK score(mRS),and the changes of patients’condition were observed within 72 hours.If a patienfs condition progressed,three tables were passed again.Scores were used to determine ’whether early neurological deterioration occurred in patients.Subsequently,patients with early neurological deterioration were divided into END group and those without early neurological deterioration were divided into non-END group.The pathological changes pattern(clinical case classification),basic factors(age,sex,past history,etc.),clinical factors(white blood cell count,blood routine,etc.),auxiliary examinations(magnetic resonance angiography,transcranial Doppler examination and carotid color Doppler ultrasonography)and baseline scores of three tables were recorded in the two groups.The results were analyzed by statistical methods and SPSS software.Their statistical significance,judging their correlation.Results:(1)106 patients were grouped according to imaging results.There were 61 patients in IWSI group and 45 patients in CWSI group.In all patients,37 patients had early neurological deterioration,the incidence of END was about 34.90%.Among them,25 patients had END in IWSI group,accounting for 40.98%.12 patients had END in CWSI group,accounting for 26.67%.According to the statistical results,although the incidence of END in IWSI group was higher than that in CWSI group,there was no significant difference between the two groups(p>0.05).At present,it can be seen that the overall incidence of END in watershed infarction patients is not low,but the pathological pattern has nothing to do with the incidence of END.(2)The statistical results of the elderly(>60y),diabetes mellitus and smoking history in 106 patients with watershed infarction were statistically significant(p<0.05).Among them,the analysis of the relationship between the elderly and smoking and END showed significant statistical significance(p<0.01).Among the three indicators,69 elderly patients had END incidence rate of 42%,37 non-elderly patients had END incidence rate of 21.6%,50 diabetic patients had END incidence rate of 50%,56 non-diabetic patients had END incidence rate of 21.5%,64 patients had smoking history,57 of them were male,the incidence of END was 43.7%,42 non-smoking patients had END incidence rate of 21.4%.There was no significant difference between the other five indicators(including gender differences,hypertension,hyperlipidemia,atrial fibrillation and drinking history)and the incidence of END(p>0.05).(3)The statistical results of eight clinical high-risk factors in END group and non-END group after admission showed that CRP,LP-PLA2,HCY and MMP-9 in peripheral blood had statistical significance(p<0.05),and the statistical results of CRP and LP-PLA2 had significant difference(p<0.01).However,there was no statistical significance in white blood cell count,LDL-C,prothrombin time and fibrinogen as indicators of vasculitis(p>0.05).(4)Among 61 patients with watershed infarction,there were 41 patients with moderate or more vascular stenosis,of which 23 patients had END,accounting for 56%,while the remaining 2 patients with severe vascular stenosis had no END.Among 36 patients with watershed infarction,there were 12 patients with moderate or more vascular stenosis,of which 5 patients had END,accounting for 41.6%.No END was found in the remaining 7 patients with CWSI pathological pattern accompanied by severe vascular stenosis.According to the statistical analysis,there was significant difference between severe vascular stenosis and END in IWSI group(p<0.01),but there was no significant difierence between "positive" and END in CWSI group(p>0.05).A total of 77 patients had carotid artery plaque,of which 27 patients had early neurological dysfunction(35.0%)and 29 patients had no atherosclerotic plaque.Ten patients still had END(52.6%).According to the statistical results,there was no significant difference between the occurrence of END and the presence of carotid artery plaque(p>0.05).In terms of plaque nature,77 patients with carotid plaque had 38 stable plaques,of which 7 had early neurological deterioration(18.4%)and 42 were unstable plaques,of which 20 had early neurological deterioration(47.6%).According to the statistical results,the nature of plaque in patients with acute watershed infarction and the occurrence of END had statistical significance(p<0.05).(5)In the initial GCS score,there were 45 patients with 10-12 points,21 patients with END,62 patients with 13-15 points and 16 patients with END.According to the statistical results,patients with initial GCS score of 10-12 had significant correlation with END(p<0.05),and patients with GCS score of 10-12 were more prone to END.After admission,the mRS scores of 106 patients were 65 with 1-2 points and 41 with 3-4 points,including 16 with 1-2 points and 21 with 3-4 points in END group.The final scores of END group were greater than or equal to 5 points.According to the statistical results,it can be seen that the incidence of END in patients with improved RANK score 3-4 at admission has significant statistical significance(p<0.01),and patients with high mRS score are more prone to END.The initial NIHSS score of 106 patients after admission showed that 62 patients had 1-3 scores,including 15 patients in END group(24.1%)and 45 patients with 4 or more scores,including 22 patients in END group(48.9%).According to the statistical results,it can be seen that the incidence of END in patients with NIHSS score of 4 or more at admission has statistical significance(p<0.01).It can be seen that patients with high NIHSS score are more prone to END.Conclusion:Among all the selected cases,patients with intermal watershed infarction are more prone to early neurological deterioration than those with external watershed infarction.The higher the initial mRS score and NIHSS score,the higher the risk of END,while the lower the GCD score,the higher the risk of END,especially the NIHSS and GCS score.Patients with history of diabetes mellitus,older age and long-term smoking,middle cerebral artery stenosis and intermal carotid artery stenosis(>50%),carotid artery unstable plaque and CRP,LP-PLA2,HCY,MMP-9 were more prone to END.Objective:To collect the cases of acute watershed cerebral infarction patients and make a retrospective analysis and Study on them,to differentiate the different types of watershed cerebral infarction patients according to TCM syndrome differentiation.On the basis of the western medicine treatment recommended by the Guidelines for the Treatment of Cerebral Infarction in 2017,to select the suitable Chinese medicine prescriptions recommended by the Guidelines for the treatment of patients,and to compare the two.Therapeutic effect of traditional Chinese medicine prescriptions was studied to explore the prospect of watershed infarction treated by traditional Chinese medicine.Methods:From September 2016 to December 2017,66 patients with watershed cerebral infarction were hospitalized in Department of Neurology and Internal Medicine of Taixing Hospital Affiliated to Yangzhou University.The diagnostic criteria for these patients were in line with the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke,2014.According to the clinical manifestations of the patients and the Guidelines for the Treatment of Cerebral Infarction in 2017,all the patients were divided into two groups:Qi deficiency and blood stasis and wind phlegm blocking collaterals.The experimental group and the control group were immediately set up in each group.The patients in the experimental group and the control group were treated routinely according to the Guidelines for the Treatment of Cerebral Infarction in 2017.On this basis,the experimental group was treated with Buyang Huanwu Decoction(plus or minus)and Tongluo Huatan Decoction(plus or minus)respectively.After 7 days of treatment,NIHSS score and mRS score were used to evaluate the therapeutic effect.Statistical methods and SPSS software were used to analyze the statistical significance and judge the curative effect of both sides.Result:(1)After the treatment of Buyang Huanwu Decoction for Qi Deficiency and Blood Stasis,three patients were basically cured,three significantly improved,four progressed,four unchanged and one deteriorated,and the total effective rate was 66.66%,In the control group,one was basically cured,three progressed,three progressed,three unchanged and four deteriorated,with a total effective rate of 57.14%.The total effective rate of the experimental group was significantly higher than that of the control group.In NIH score,the NIH scores of the experimental group before and after treatment were significantly different,with statistical significance.The NIH scores of the control group before and after treatment were not significantly different,without statistical significance.The horizontal comparison of the NIH scores of the experimental group and the treatment group after treatment indicated statistical significance.In the aspect of mRS score,the difference of mRS score between the experimental group and the control group before and after treatment is statistically significant.The horizontal comparison of mRS score between the experimental group and the treatment group after treatment indicates that there is no statistical significance.(2)After adding Tongluo Huatan Decoction,the experimental group basically cured 1 person,made significant progress 4 people,made progress 9 people,no change 2 people,deteriorated 3 people,the total effective rate was 73.68%,while the control group basically cured 1 person,made significant progress 3 people,made 6 people,made no change 3 people,deteriorated 5 people,the total effective rate was 55.55%.The total effective rate of the experimental group was significantly higher than that of the control group.NIHSS score,the experimental group before treatment and after treatment NIH score difference is significant,with statistical significance,the control group before treatment and after treatment NIH score difference is not significant,there is no statistical significance(p<0.05 statistical significance).The experimental group and treatment group after treatment NIH score horizontal comparison results suggest that there is statistical significance(p<0.05).Statistical significance).In terms of mRS score,there was no significant difference between the experimental group and the control group before and after treatment(p<0.05).There was significant difference between the experimental group and the treatment group after treatment(p<0.05).Conclusion:Buyang Huanwu Decoction and Tongluo Huatan Decoction can effectively improve the prognosis of watershed infarction with different syndromes.Buyang Huanwu Decoction can improve the direct prognosis of patients with watershed infarction of Qi-blood-stasis type.Tongluo Huatan Decoction can improve the direct prognosis of patients with "wind-phlegm obstruction of collaterals" watershed infarction,and play a role in functional recovery,can improve the long-term prognosis of patients.