Efficacy Study Of Early Treatment Plan For Acute Ischemic Stroke Based On TCM Syndrome Elements In The Initial State

Stroke disease is now a serious threat to human health and has become the focus of medical research.Stroke disease has the characteristics of high morbidity,high mortality,high disability rate,high recurrence rate,multiple complications and low cure rate.It is the central nervous system disease with the highest disability rate and mortality rate at present,which poses a huge threat to human life and health.At present,although the research on stroke has become increasingly mature in the society,and most of them focus on the quantitative scoring research of the syndromes,there is a lack of active and effective treatment for stroke at the early stage based on the elements of the initial state syndrome of stroke.Therefore,based on the elements of the initial state syndrome of stroke,To evaluate and study the early treatment of acute ischemic stroke in patients with TCM syndrome elements and neurological function scores,etc.This paper consists of three parts:literature review,Meta analysis and clinical study on the clinical efficacy of Xingnaojing injection combined with alteplase in the treatment of acute ischemic stroke.The first part is literature review.Stroke is a common disease in the internal medicine system of traditional Chinese medicine.Since "Huangdi Neijing",doctors of all generations have continuously improved their understanding of the etiology and pathogenesis of stroke,as well as the syndrome and treatment of stroke.By summarizing the understanding of apoplexy by doctors in the past dynasties,the etiology and pathogenesis of apoplexy are summarized to understand the discussion and drug use of apoplexy by doctors in various historical periods,and to understand the origin of the occurrence and development of apoplexy.Combined with clinical practice and the influence of modern medicine on the research of apoplexy and modern medical treatment on the syndrome differentiation of apoplexy patients,By summarizing the common characteristics of the syndromes of stroke patients,this paper proposes the significance and importance of studying the syndromes of TCM in the initial state of stroke based on the distribution of the syndromes of TCM in the initial state of stroke,as well as the clinical treatment status of acute ischemic stroke,so as to provide certain clinical reference for the clinical diagnosis and treatment of stroke.The second part is the Meta data analysis,and the evaluation of the clinical efficacy of Xingnaojing injection combined with alteplase in the treatment of acute ischemic stroke.The results of Meta-analysis showed that the incidence of adverse reactions of Xingnaojing combined with alteplase was less than that of the control group,and Xingnaojing combined with alteplase had significant therapeutic effect on AIS patients.The combination of the two could significantly improve the neurological deficit and cognitive function of AIS patients.Significantly improved NIHSS and MOCA scores in patients with acute ischemic stroke.The third part is clinical researchObjective:To study the distribution characteristics of TCM syndrome elements in the initial state of acute ischemic stroke patients.Based on the elements of TCM syndromes in the initial state of stroke,the efficacy and preliminary mechanism of early treatment for patients with acute ischemic stroke were studied.Methods:With the method of prospective,randomized,controlled study,using the random number table method will met inclusion exclusion criteria of acute ischemic stroke patients were divided into two parts,the control group and treatment group according to the guidelines for treatment principle,be consistent in western medicine control group and treatment group,within the time window thrombolysis,according to patients’ condition,to carry on the control of blood pressure,bed rest,Maintain airway patency,reduce intracranial pressure when necessary,neuroprotection and other treatments.On the basis of control group,the treatment group was given stroke initial state tongzhi prescription(formula granules)orally or nasal feeding,1 dose a day,morning and evening;Gastrodin injection,Tanreqing injection or Xingnaojing injection were added according to patients’ TCM syndrome elements.The course of treatment was 3 days.The scores of neurological function scale,TCM syndrome factor scale,and th e changes of serum MMP9 and VEGF were observed and recorded at the time of enrollment,day 3,day 7 and day 14.To explore the distribution characteristics of TCM syndrome elements in the initial state of AIS,and to evaluate the effect of early treatment on the neurological function of patients with acute ischemic stroke and its preliminary mechanism.Results:1.When patients with acute ischemic stroke were enrolled,scores of syndrome elements of wind syndrome,heat syndrome and phlegm syndrome were all ≥7 points,indicating that the syndromes were established.The primary TCM syndrome elements of the initial state of acute ischemic stroke were wind syndrome,heat syndrome and phlegm syndrome.2.This study included and collected the TCM syndrome elements information of patients in the control group and the treatment group at the time of enrollment,the 3rd,7th and 14th day.According to the changes and evolution of TCM syndrome elements,the efficacy of early treatment scheme on TCM syndrome elements in patients with acute ischemic stroke was analyzed.In the group,two groups there was no significant difference between the TCM syndrome elements,in the 14 days of the control group and treatment group of TCM syndrome factor score of two groups of wind syndrome,heat syndrome,phlegm and stasis syndrome score improvement especially,in the process of evolving of syndrome elements,stasis in the clinical course of patients with acute ischemic stroke also occupies the important position.In this study,neurological function level scores and quality of life scores of patients in the control group and the treatment group were included and collected at the time of enrollment,the 3rd,7th and 14th day.After initial state TongZhi prescription and early treatment with intravenous preparations of traditional Chinese medicine according to related syndrome factors,On the 14th day,the NIHSS score,BI index and MRS score of the AIS patients in the treatment group were significantly different from those in the treatment group,and their scores were significantly decreased,indicating that the protection of neurological function and the promotion of the recovery of neurological function of patients are of great significance.3.Serums of patients were collected in this study to determine and test MMP9 and VEGF in the serum,and to preliminarily explore the influence of early treatment on MMP9 and VEGF in AIS serum.Early treatment regimens can reduce serum MMP9 and promote VEGF in patients with acute ischemic stroke.Early treatment regimens can effectively inhibit the growth of serum MMP9,promote the growth of vascular endothelial cells,and have a protective effect on brain tissue,reduce injury factors and promote recovery factors.Conclusion:The primary TCM syndromes of AIS patients are mainly wind syndrome,heat syndrome and phlegm syndrome.The general prescription for initial state of stroke and the early treatment of intravenous preparation of traditional Chinese medicine can reduce the scores of initial state of TCM syndrome elements in patients according to the different manifestations of initial state of TCM syndrome elements,which has a certain improvement effect on TCM syndrome elements,especially the influence on wind syndrome,heat syndrome and phlegm syndrome is most significant.At the same time,it can effectively improve the level of neurological function of patients,to a certain extent,can restore the neurological function of patients,has a protective effect on the neurological function of patients with acute ischemic stroke,and improve the quality of life of patients with AIS.Early treatment regimens reduce serum MMP9 and promote VEGF in patients with acute ischemic stroke.