A Retrospective Analysis On Related Risk Factors And Traditional Chinese Medicine Syndrome Of Post-stroke Seizures Among Acute Ischemic Stroke Treated With Reperfusion Therapy

Background:Reperfusion therapy has become the standard treatment for acute ischemic stroke,which can effectively improve patient outcomes and reduce mortality.Existing studies have found that reperfusion therapy may increase the incidence of post-stroke seizures and post-stroke epilepsy,and studies have shown that post-stroke seizures are related to the adverse outcome of acute ischemic stroke.However,this view is still controversial.Therefore,this study conducted a retrospective analysis to investigate the incidence,risk factors and clinical prognosis of patients with acute ischemic stroke combined with post-stroke epileptic seizures who received different reperfusion treatments in the Stroke Center of Zhongshan Hospital Affiliated to Guangzhou University of Chinese Medicine in the past 6 years and explore the distribution of Traditional Chinese Medicine syndrome types in patients with acute ischemic stroke combined with post-stroke seizures who received different reperfusion therapy.The purpose of this study is to improve clinicians’ understanding of post-stroke seizures,thus to strengthen the individual management of patients undergoing reperfusion therapy and provide the basis for further Traditional Chinese Medicine syndrome diagnosis and treatment.I.Literature ResearchSearches Chinese databases,including:CNKI,CBM,CAJD,VIP and Wanfang databases,etc.Foreign language databases,including:Medline,Pubmed,Embase,Cochrane,JSTOR,LISTA,OVID,Springer,Wiley,etc.To sort out the changes in the definition of PSS and PSE in the past 10 years,analyze the clinical research on the correlation between different blood flow reperfusion therapy and PSS and PSE,and trace the source of traditional Chinese medicine for seizures after stroke.In order to perfect the research design of the subject,make preparations for clinical retrospective research.Ⅱ.Retrospective study of post-stroke seizures among acute ischemic stroke treated with reperfusion therapyObjective:To investigate the incidence,risk factors,clinical features,electroencephalogram features,and short-term outcomes of AIS patients with PSS who received different reperfusion treatments in the Stroke Center of Zhongshan Hospital Affiliated to Guangzhou University of Chinese Medicine in the past 6 years.Methods:To develop the clinical information collection questionnaire of Clinical Information Registration Questionnaire for Acute Ischemic Stroke Reperfusion Therapy.A total of 939 patients with acute ischemic stroke who received blood flow reperfusion therapy in the Stroke Center of Zhongshan Hospital Affiliated to Guangzhou University of Chinese Medicine from January 2014 to December 2019 were reviewed.891 subjects were selected according to inclusion criteria and exclusion criteria.The clinical information of the research subjects was entered according to the Clinical Information Registration Questionnaire for Acute Ischemic Stroke Reperfusion Therapy.Different contrast cohorts were formed and singlefactor comparison analysis was conducted in turn according to whether combine with PSS,short-term adverse outcomes and different reperfusion therapy.The variables of P<0.1 were brought into the binary logistic regression equation to investigate the risk factors of different outcomes.According to the principle of statistics,this study estimated the sample size of the multiple regression analysis involved in this survey by using PASS 15 software.In statistical description,Kolmogorov-Smirnov method was used to test the normality of the measurement data.If the data were in accordance with normal distribution,the measurement was expressed by mean plus or minus standard deviation(x±s),and the comparison between groups was performed by independent sample t test;Non-normal measurement data were expressed by median and interquartile range(M,IQR)and differences between groups were analyzed by Mann-Whitney U test or Kruskal-Wallis test.Categorical data were expressed in terms of frequency and percentage,and comparisons between groups were made using χ2 or Fisher’s exact test;Logistic Regression analysis was used to analyze the risk factors,and the factors of single factor analysis(P<0.1)were taken as the prognosisrelated factors,and the multivariate Logistic regression analysis was introduced(specific method:input method).SPSS 26.0 software was used for statistical data calculation,and P<0.05 was taken as statistical significance by two-side test.Results:1.There were 23 patients with PSS who received reperfusion therapy,who accounted for 2.58%(23/891)of the patients receiving reperfusion therapy in the same period.2.Univariate analysis between the PSS cohort and the non-PSS cohort showed that there were significant differences in diabetes,fasting blood glucose,admission NIHSS score,stroke severity,low ASPECT in the early stage of stroke,cortical infarction,IVT,EVT,aICH,PHI and PH2(P<0.05).3.Multivariate analysis showed moderate stroke[taking mild stroke as a reference,moderate stroke:(OR 4.092,95%CI 1.188～14.101;P=0.026)],Severe stroke(OR 7.542,95%CI2.096～27.134,P=0.002)and PHI(OR 3.943,95%CI 1.110～14.007,P=0.034),aICH(OR 3.280,95%CI 1.114～9.658,P=0.031)were independent predictors of AIS patients combining with PSS after reperfusion therapy.4.Our study showed that PSS(OR 4.512,95%CI 1.344～15.150,P=0.015)was an independent risk factor for predicting short-term adverse outcome after AIS reperfusion therapy.5.The clinical seizure characteristics of 23 patients with PSS were classified and analyzed.39.1%(9/23)received IVT,13.0%(3/12)takes IVT+EVT and 47.8%(11/23)takes EVT.It was found that 69.6%(16/23)patients had seizures within 24 hours of onset,and 21.7%(5/23)were associated with status epilepticus.39.13(9/23)patients underwent persistent EEG,of which 33.33%(3/9)were diagnosed as non-convulsive status epilepticus.The incidence of HT was 47.8%(11/2).According to ECASSII HT imaging classification,17.3%(4/23)occurred for hemorrhagic cerebral infarction and(PH)30.4%(7/23)occurred for cerebral parenchymal hemorrhage.The incidence of symptomatic cerebral hemorrhage was 17.4%(4/23).The incidence of asymptomatic cerebral hemorrhage was 30.4%(11/23).6.The incidence of PSS in IVT,IVT+EVT and EVT was statistically different(P<0.05),the incidence of PSS in EVT was 5.2%>IVT+EVT 2.5%>IVT 1.6%.Conclusion:The overall incidence of PSS in AIS reperfusion therapy is 2.58%,1.6%in IVT,2.5%in bridging therapy,and 5.2%in EVT;only 2.71%(9/331)of AIS patients admitted to the neuro-intensive care unit after intravascular intervention After continuous EEG monitoring,the incidence of NCSE in all patients who received continuous EEG monitoring reached 33.3%;the independent risk factors for PSS after reperfusion treatment were:the severity of ischemic stroke,asymptomatic cerebral hemorrhage transformation,brain Parenchymal hemorrhage type 1(PH-1);factors affecting the short-term adverse outcome of AIS patients after reperfusion therapy include;PSS,ASPECT<7,cortical involvement,sICH;comparison of the risk of PSS with different reperfusion therapy,EVT increases the risk of PSS,but could not rule out the interfering factors of the severity of stroke.Ⅲ.A Study on the distribution of TCM syndrome types of post-stroke seizures patients among acute ischemic stroke with reperfusion therapyObjective:To investigate the distribution of TCM syndrome types in patients with acute ischemic stroke combined with post-stroke epileptic seizures who received different reperfusion treatments,and to provide the basis for further TCM syndrome diagnosis and treatment.Methods:According to the“Acute Ischemic Stroke Reperfusion Therapy Clinical Information Registration Questionnaire”,the TCM syndrome information of the research object was extracted,and the collected TCM clinical data and data were entered into the database by EXCEL and analyzed with the statistical software SPSS26.0.A descriptive analysis was used for the distribution of syndrome types of AIS patients with different reperfusion treatments,and the distribution of PSS and non-PSS syndromes.Results:1.In the study of syndrome types of traditional Chinese medicine,in the whole cohort the stroke of meridians and collaterals were 80.4%(716/891),and the stroke of internal organs was 19.6%(175/891).Distribution of syndrome types of the stroke of meridians and collaterals:wind-phlegm blocking collaterals:44.9%(392/891)>phlegm-heat and bowelrepletion type:16.3%(150/891)>wind-fire disturbance type:13.9%(124/891)>qi deficiency and blood stasis type:3%(27/891)>wind formation from yin deficiency type:2.7%(23/891);Stroke of internal organs:phlegm-heat internally blocking type:11.0%(98/891)>phlegm clouding clear orifices type:6.7%(60/89)>psych failure 1.9%(17).2.In terms of the distribution of TCM syndrome types of patients with different reperfusion therapy,the diagnosis of meridian syndrome in stroke in IVT group,bridging group and EVT group was mainly focused on windphlegm blocking collaterals type:53.4%(299/560),36.1%(43/119),23.6%(50/212).In the classification of stroke of internal organs,most of the patients received endovascular interventional therapy(mainly focused on phlegm-heat occlusive orifices),24.4%(29/119)were in IVT+EVT group and 25.5%(54/212)were in EVT group.3.The proportion of meridians and collaterals in stroke in patients with PSS was lower than that in the control group,while the proportion of stroke of internal organs was higher than that in the control group.The meridians and collaterals in stroke were mainly focused on phlegm-heat and bowel-repletion type,while the stroke of internal organs was mainly focused on phlegm-heat internally blocking type.Conclusion:We found that the TCM syndrome type of acute ischemic stroke reperfusion therapy combined with post-stroke epilepsy were mainly focused on the syndrome of phlegm-heat and bowel-repletion in stroke of meridians and collaterals,and syndrome of phlegm-heat internally blocking in stroke of internal organs.