| Objective :Based on the TCM evidence system,the distribution and evolution of the evidence of Stroke-associated pneumonia(SAP)were investigated,and the risk factors of SAP were analyzed,in order to improve the clinical ability to identify the risk of SAP at an early stage and to warn the adverse prognosis of stroke.Method :1.Using the method of literature study,we analyzed the basic information characteristics,distribution of evidence elements and pattern of evidence combination of post-stroke pulmonary infection.2.Using a prospective survey combined with a cross-sectional survey,a total of 194 acute ischemic stroke patients admitted within 72 hours of onset were included,and basic information(including gender,age,Rankin Rating Scale(mRS),past history,personal history,family history and comorbidities)was collected;Laboratory tests(including routine blood indicators,blood glucose)at admission,at 7 days of onset(or occurrence of SAP);National Institutes of Health Stroke Scoring Scale(NIHSS)and Swallowing Screening Scale.The information collected was entered into the CRF table disease database.Patients were divided into 2 groups according to the occurrence of SAP,and the cardinality test and non parametric test were used to compare the differences of the above indicators and the distribution and combination pattern of the evidence elements;The cardinality test and the point two column method were used to analyze the correlation between the difference parameters and the occurrence of SAP;The logistic method was used to analyze the risk factors of SAP.Result :1.The literature study found that the patients with post-stroke pulmonary infection were male biased,the type was mainly cerebral infarction,the number of combined cases were hypertension,coronary heart disease,diabetes mellitus,hyperlipidemia and stroke in descending order,the proportion of Chinese medicine evidence elements were phlegm-damp,internal fire,qi deficiency,blood stasis,internal wind and yin deficiency in descending order,the combination pattern of evidence was mostly single and two evidence,with phlegm-damp and internal fire predominant.2.Comparison of patients’ basic data in the clinical study: the gender of patients in SAP group(38 cases)and Non-SAP group(156 cases)was not statistically significant(P>0.05);The age of patients in SAP group was 79.50(65.50-84.25)years old,which was higher than that of Non-SAP group and was statistically significant(P<0.01);The number of cases of non-first stroke patients in both groups was not statistically significant(P>0.05);The mRS score of 3.00(3.00-3.00)in the SAP group was higher than that in the Non-SAP group,which was statistically significant(P<0.01);The number of patients with previous medical history in both groups was not statistically significant(P>0.05);9(23.7%)patients with previous atrial fibrillation in the SAP group compared with 12(7.7%)patients in the Non-SAP group,which was statistically significant(P<0.01);The number of smokers,alcohol drinkers,and patients with family history in both groups were not statistically significant(P>0.05);38(100%)patients in the SAP group had combined complications,compared with 77(49.4%)in the Non-SAP group,which was statistically significant(P<0.01);35(92.1%)patients in the SAP group had combined dysphagia,compared with 49(31.4%)in the Non-SAP group.SAP group with dysphagia 35 cases(92.1%),compared with 49 cases(31.4%)in the Non-SAP group,which was statistically significant(P<0.01);6 patients(15.8%)with urinary retention in the SAP group,compared with 1 case(0.6%)in the Non-SAP group,which was statistically significant(P<0.01);7 patients(18.4%)with urinary incontinence in the SAP group,compared with 8 cases(5.1%)in the Non-SAP group,which was statistically significant(P<0.01).3.Comparison of laboratory indexes at admission: White blood cell count(WBC)was higher in the SAP group than in the Non-SAP group,with statistical significance(P<0.05);Neutrophil count(N)was higher in the SAP group than in the Non-SAP group,with statistical significance(P<0.01);Lymphocyte count(L)was lower in the SAP group than in the Non-SAP group,with statistical significance(P<0.01);The Neutrophil/Lymphocyte ratio(NLR)of patients in the SAP group was higher than that of the Non-SAP group,which was statistically significant(P<0.01);The blood glucose(GLU)values of the two groups were not statistically significant(P>0.05).4.The NIHSS score of 10.00(7.75-14.00)in the SAP group at admission was higher than that in the Non-SAP group,which was statistically significant(P<0.01).Grading the NIHSS score according to severity,there was no statistical significance(P>0.05)in both groups when the score was mild(0-4)and statistically significant(P<0.01)when it was moderate to severe(≥ 5).The SAP group Grade 3(1-3)of dysphagia was statistically significant(P<0.01)compared with grade 4(3-4)in the Non-SAP group.5.Correlation analysis showed that age,dysphagia,urinary retention,NLR,NIHSS score and dysphagia grade were correlated with the occurrence of SAP(correlation coefficient >0.3).Among them,age(β =0.122,OR=1.130,P<0.01),NLR(β =0.275,OR=1.317,P<0.01),NIHSS score(β=0.451,OR=1.570,P<0.01)and dysphagia grade(the higher the score,the less dysphagia)(β=-1.268,OR= 0.281,P<0.05)were risk factors for SAP.6.Distribution pattern of TCM evidence at admission:(1)34 cases(89.5%)of internal wind evidence,34 cases(89.5%)of phlegm-damp evidence and 36 cases(94.7%)of qi-deficiency evidence in the SAP group were statistically significant compared with 102cases(65.4%)of internal wind evidence,37 cases(23.7%)of phlegm-damp evidence and 115cases(73.7%)of qi-deficiency evidence in the Non-SAP group(P<0.01);There was no statistical significance between the two groups for internal fire evidence,blood stasis evidence and yin deficiency evidence(P>0.05).(2).(2)The SAP group had10.00(10.00-20.00)points for internal wind evidence,15.50(13.00-18.00)points for phlegm-dampness evidence,and 25.00(23.00-30.00)points for qi deficiency evidence,which were statistically significant(P<0.01)compared with 10.00(0-20.00)points for internal wind evidence,7.00(4.25-9.00)points for phlegm-dampness evidence,and 14.00(9.00-23.00)points for qi deficiency evidence in the non-SAP group;The scores for internal fire evidence,blood stasis evidence,and yin deficiency evidence in the two groups no statistical significance(P>0.05).(3).There were 24 cases(63.2%)and 4 cases(10.5%)of four-evidence combinations in the SAP group compared with the Non-SAP group,which was statistically significant(P<0.01);There were 52 cases(33.3%)and 65 cases(41.7%)of two-evidence combinations in the Non-SAP group compared with the SAP group,which was statistically significant(P<0.05);There was no statistical significance in the single-evidence type of both groups(P>0.05).(3).There were 24 cases(63.2%)of four-evidence combination and 4 cases(10.5%)of five-evidence combination in the SAP group than in the Non-SAP group,which was statistically significant(P<0.01);There were 52 cases(33.3%)of two-evidence combination and 65 cases(41.7%)of three-evidence combination in the Non-SAP group than in the SAP group,which was statistically significant(P<0.05);There was no statistically significant single-evidence type in the two groups(P>0.05).7.The distribution of TCM symptoms at 7 days of onset(or occurrence of SAP):(1).28cases(73.7%)of internal wind evidence,18 cases(47.4%)of internal fire evidence,38 cases(100%)of phlegm-damp evidence,35 cases(92.1%)of qi deficiency evidence,and 14 cases(36.8%)of yin deficiency evidence in the SAP group,compared with 23 cases(14.7%)of internal wind evidence,22 cases(14.1%)of internal fire evidence,28 cases(17.9%)of phlegm-damp evidence,75 cases(48.1%)of qi deficiency evidence,and 3 cases(1.9%)of yin deficiency evidence in the Non-SAP group in the Non-SAP group,which was statistically significant(P<0.01);There was no statistical significance for blood stasis evidence in both groups(P>0.05).(2).The SAP group had 10.00(0-20.00)points for internal wind evidence,8.00(3.75-14.25)points for internal fire evidence,18.00(9.50-18.00)points for blood stasis evidence,23.50(18.75-27.25)points for phlegm-dampness evidence,25.00(21.75-31.00)points for qi deficiency evidence,and 5.00(5.00-15.00)points for yin deficiency evidence,compared with the Non-SAP group with 0(0-0)points for internal wind evidence,3.00(3.00-4.00)points for internal fire evidence,14.00(10.00-18.00)points for blood stasis evidence,6.00(2.25-8.00)points for phlegm-dampness evidence,9.00(0-14.00)points for qi deficiency evidence,and 5.00(5.00-5.00)points for yin deficiency evidence,which was statistically significant(P<0.05).(3)There were 14(36.8%)cases of four-evidence combination and 17(44.7%)cases of five-evidence combination in the SAP group compared with the Non-SAP group,which was statistically significant(P<0.01);There were 52(33.3%)cases of single-evidence type and 81(51.9%)cases of two-evidence combination in the Non-SAP group compared with the SAP group,which was statistically significant(P<0.05).there was no statistical significance in the two groups without evidence type and three evidence combinations(P>0.05).8.Evolution pattern of TCM evidence elements:(1)5 cases(13.2%)of internal fire evidence and 5 cases(13.2%)of yin deficiency evidence at the time of admission in the SAP group were statistically significant compared with 18 cases(47.4%)of internal fire evidence and 14 cases(36.8%)of yin deficiency evidence at the time of pneumonia(P<0.05);Internal wind evidence,blood stasis evidence,phlegm-dampness evidence,and qi deficiency evidence before and after the occurrence of pneumonia in the SAP group were no statistical significance(P>0.05);There were 102 cases(65.4%)of internal wind evidence and 115 cases(73.7%)of qi deficiency evidence at the time of admission in the Non-SAP group,which were statistically significant compared with 23 cases(14.7%)of internal wind evidence and 75cases(48.1%)of qi deficiency evidence at 7 days of onset(P<0.01);There were no statistically significant differences between internal fire evidence,blood stasis evidence,phlegm-dampness evidence and yin deficiency evidence at the time of admission and 7 days of onset in the non-SAP group(P>0.05).(2).The SAP group had 3.50(3.00-7.00)internal fire evidence points,15.50(13.00-18.00)phlegm-damp evidence points,and 5.00(5.00-5.00)yin-deficiency evidence points at the time of admission,which were statistically significant compared with 8.00(3.75-14.25)internal fire evidence points,23.50(18.75-27.25)phlegm-damp evidence points,and 5.00(5.00-15.00)yin-deficiency evidence points at the time of pneumonia(P<0.01);There was no statistical significance in the SAP group before and after the onset of pneumonia for internal wind,blood stasis and qi deficiency evidence(P>0.05);In the Non-SAP group,there were 10.00(0-20.00)internal wind evidence,3.00(3.00-8.75)internal fire evidence,18.00(10.00-18.00)blood stasis evidence,7.00(4.25-9.00)phlegm-damp evidence,and 14.00(9.00-23.00)qi deficiency evidence at the time of admission,compared with 0(0-0)for internal wind evidence,3.00(3.00-4.00)for internal fire evidence,14.00(10.00-18.00)for blood stasis evidence,6.00(2.25-8.00)for phlegm-dampness evidence,and 9.00(0-14.00)for qi deficiency evidence at 7 days of onset,which were statistically significant(P<0.01);There was no statistically significant difference between the yin deficiency evidence of patients in the Non-SAP group at admission and at 7days of onset(P>0.05).(3).24 cases(63.2%)of four-evidence combinations and 4 cases(10.5%)of five-evidence combinations at the time of admission in the SAP group were statistically significant compared with 14 cases(36.8%)of four-evidence combinations and17 cases(44.7%)of five-evidence combinations at the time of pneumonia(P<0.05);2 cases of two-evidence combinations and 8 cases of three-evidence combinations before and after the onset of pneumonia in the SAP group were not statistically(P>0.05);In the Non-SAP group,there were 10 cases(6.4%)of single-evidence type,52 cases(33.3%)of two-evidence combination,65 cases(41.7%)of three-evidence combination,and 29 cases(18.6%)of four-evidence combination at the time of admission,compared with 52 cases(33.3%)of single-evidence type,81 cases(51.9%)of two-evidence combination,20 cases(12.8%)of three-evidence combination,and 1 case(0.6%)of four-evidence combination at 7 days after the onset of pneumonia.combination in 1 case(0.6%),which was statistically significant(P<0.01);There was no statistical significance(P>0.05)between the Non-SAP group of patients admitted to the hospital and the non-evidence type at 7 days of onset.Conclusions :1.There were significant differences in age,mRS score,atrial fibrillation,dysphagia,urinary retention,urinary incontinence,WBC,N,L,NLR,NIHSS score and dysphagia grade between the two groups;age,dysphagia,urinary retention,NLR,NIHSS score and dysphagia grade were correlated with the occurrence of SAP;among them,age,NLR,NIHSS score and dysphagia were risk factors for the occurrence of SAP.2.The evidence elements at the time of admission in the SAP group were mainly internal wind,blood stasis,phlegm-dampness and qi deficiency,and the combination pattern was based on the combination of four evidence elements,and the combination of evidence elements was more complicated after the occurrence of SAP with the aggravation of internal fire evidence and yin deficiency evidence;the evidence elements at the time of admission in the non-SAP group were mainly internal wind,blood stasis and qi deficiency,and the combination pattern was based on the combination of two and three evidence elements,and the combination of evidence elements tended to be simplified with the alleviation of internal wind evidence and qi deficiency evidence at 7 days after the onset of SAP. |
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