A Retrospective Study Of Combined Traditional Chinese And Western Medicine In Treating Intracerebral Hemorrhage Patients After Surgery With Stroke-associated Pneumonia

BackgroundIntracerebral hemorrhage is one of the emergency neurosurgery.The patients after surgery can reduce the risk of death and disability,but stroke-associated pneumonia is one of the most common complications of the intracerebral hemorrhage after surgery.It can aggravate the condition,extend the length of hospital stay,as well as increase the mortality and economic burden,which is taken seriously in clinical now.Traditional Chinese medicine treating stroke-related pneumonia has a great space for development,but there is no unified syndrome types differentiation or treatment methods yet.ObjectiveThe data of intracerebral hemorrhage patients after surgery with stroke-associated pneumonia were retrospectively analyzed,for analysing the syndrome types and their prognosis,the rule of formulas using and their curative effect evaluation.So we can provide some clinical basis for further research and research ideas for Chinese medicine treating ntracerebral hemorrhage patients after surgery with stroke-associated pneumonia.MethodsThis research used the method of retrospective study,to collect the stroke baseline data,information related to the operation,the pathogens and antimicrobial drug use,syndrome types and formulas,respiratory function index,inflammation index,nerve function index,total hospitalization days and total hospitalization expenses of the intracerebral hemorrhage patients after surgery with stroke-associated pneumonia,and to statistical analysis these data.Results1.General information of included casesA total of 179 effective cases were included,including 118 male patients(65.9%)and 61 female patients(34.1%).The age of them were from 20 to 80 years old,of which the average was(60.63±13.795)years old.39 patients(21.8%)had a history of smoking and 23(12.8%)had a history of alcoholism.The most common basic diseases were hypertension in 154 cases(89%),diabetes in 25 cases(14%)and cerebrovascular malformation in 17 cases(9.4%).The most common bleeding sites were basal ganglia in 89 patients(49.7%),lobe in 62 patients(34.6%),corona radiata in 44 patients(24.6%)and thalamus in 36 patients(20.1%).2.The pathogens of sputum culture and the use of antimicrobial agentsThe top 4 sputum culture positive pathogens were acinetobacter baumannii(49 cases,27.4%),staphylococcus aureus(28 cases,15.6%),pseudomonas aeruginosa(27 cases,15.1%),klebsiella pneumoniae(25 cases,14%).A total of 86 patients(48%)were treated with broad-spectrum beta-lactamides/beta-lactamase inhibitors and 78(43.6%)with carbapenem antibiotics.3.TCM syndrome types differentiation and efficacy evaluation of formulasAmong the 179 patients included in this study,there were 39 cases(21.8%)of wind-phlegm-fire hyperactivity,31 cases(17.3%)of wind-fire hyperactivity,22 cases(12.30%)phlegm-heat relieving excess,49 cases(27.4%)of resistance of wind and phlegm with blood stasis,30 cases(16.8%)of phlegm-dampness stagnation,5 cases(2.8%)of qi deficiency causing blood stasis,3 cases(1.7%)of stirring wind due to yin deficiency.In syndrome type of wind-phlegm-fire hyperactivity,APACHE II score,mRS score in lingjiaogouteng decoction group decreased compared with that before treatment(P<0.05);APACHE II score,CRP in tianmagoutengyin decoction group decreased significantly compared with that before treatment(P<0.01).In syndrome type of wind-fire hyperactivity,the respiratory function system score of lingjiaogoutengtang decoction group decreased compared with that before treatment(P<0.05);CRP of tianmagoutengyin decoction group decreased compared with that before treatment(P<0.05).In syndrome type of phlegm-heat relieving excess,WBC in chengqi decoction group decreased compared with that before treatment(P<0.05);CRP in ditan decoction group decreased significantly compared with that before treatment(P<0.01).In syndrome type of resistance of resistance of wind and phlegm with blood stasis,APACHE II score,WBC,CRP and respiratory function system in tianmagouteng decoction group decreased significantly compared with that before treatment(P<0.01).In syndrome type of phlegm-dampness stagnation,CRP and respiratory function system in ditan decoction group decreased significantly compared with that before treatment(P<0.01).4.Analysis of respiratory function and prognosis of each syndrome typeThe duration of hospitalization without ventilation was shorter with syndrome type of phlegm-heat relieving excess.The inpatient survival rate and 90-day survival rate in syndrome types of phlegm-heat relieving excess and qi deficiency causing blood stasis were lower.There was no difference in the total length of hospitalization and the total cost of hospitalization among all the syndrome types.5.Survival analysisReceived external ventricular drainage and syndrome type of phlegm-heat relieving excess were all independent risk factors for the intracerebral hemorrhage patients after surgery with stroke-associated pneumonia.The risk of death was higher in patients who received external ventricular drainage than in patients who did not receive external ventricular drainage.The mortality risk of patients with syndrome type of phlegm-heat relieving excess was higher than that of patients with syndrome type of wind-phlegm-fire hyperactivity.Conclusion1.In terms of western medicine,the use of antibiotics should consider the coverage of acinetobacter baumannii,staphylococcus aureus,pseudomonas aeruginosa and drug-resistant bacteria.And we recommended to use beta-lactamides/beta-lactamase inhibitors or carbapenems for the treament.2.In terms of traditional Chinese medicine,wind syndrome,fire(heat)syndrome,phlegm syndrome should be considered in differentiation of syndrome types.Patients with wind syndrome and heat syndrome are recommended to use tianmagoutengyin decoction.Patients with phlegm syndrome are recommended to use ditantang decoction.Chengqi decoction is recommended for patients with syndrome type of phlegm-heat relieving excess.Treating from the shaoyang channel and use chaihu decoction may be a new way to treat the intracerebral hemorrhage patients after surgery with stroke-associated pneumonia.3.In other aspects,clinicians should strengthen postoperative care for patients who accepted external ventricular drainage,or choose better surgery ways,to prevent the occurrence of complications such as intracranial infection,hydrocephalus and rehemorrhage,which can reduce the risk of death.The prognosis and respiratory function of the patients with syndrome type of phlegm-heat relieving excess are relatively poor,so they shouled be treat by purging fu-organs to eliminate heat and be focus on the respiratory function.