A Study On The Hemodynamics Of Stroke And The Evidence

[Background] This study is a part of the National Twelve-Five science and technology support program, which is "Inheritance Research:Wang Yong-yan’s therapeutic experience of resolving phlegm and relaxing bowels on the treatment of stroke" belonging to "Inheritance Research: the feature therapeutic principles and methods of famous old TCM doctors. I". We do the correlation research respectively between traditional Chinese medicine (TCM) syndrome elements and laboratory index for 98 cases of stroke patients during hospital. On this basis, we make the comprehensive judgements on the hemodynamics and TCM elements including the type of phlegm heat and bowel excess, through establish the artificial neural network model. Also.57 cases of acute phase of cerebral infarction patients with phlegm heat and bowel excess were recuited to evaluation the two time points of TCM elements.Under the intervention of curative effect evaluation and hemodynamic index of correlation analysis, and on this basis by artificial neural network model is set up to evalue the situation of traditional Chinese medicine syndrome elements. From the perspective of hemodynamics, application of backward neural network technology to detect the stroke syndrome. Summary the clinical appliance of Wang Yong-yan’s therapeutic experience of resolving phlegm and relaxing bowels on the treatment of stroke, analyze and conclude the specific feature of the laws of therapeutic principles and methods of famous old TCM doctors, in that case to support the clinical research. We propose to dig out the TCM syndrome elements from the inner link between related parameters of hemodynamics, and apply the new technique for detecting hemodynamics and on the analysis of data mining, constantly continue to enrich the content of TCM syndrome differentiation and treatment, with our works, we try to show the dynamic evolution characteristics, which in the process of stroke with phlegm heat and bowel excess. And provide new perspectives and testified to the stroke treatment of combined traditional Chinese medicine and western medicine. [Objective] We try to figure out the relationship between hemodynamic and the TCM elements of stroke in the clinical hospital patients, as well as the situation change of phlegm heat and bowel excess appeared in before and after treatment. And to establish an artificial neural network model to comprehensive judge the stroke syndromes, to dig out the Wang Yong-yan’s therapeutic experience of resolving phlegm and relaxing bowels on the treatment of stroke, from the view of "multi-dimensional space-time" angle.[Method] (1) Collect the clinical hosipital patient of stroke. Summarize the medical history, the datas of TEG and relative of coagulation indexes, through the frequency analysis of the TCM syndrome and blood index correlation under the different stroke stages. To find out the dynamic change of phlegm heat and bowel excess during the whole period of stroke. Thus, to establish the BP artificial neural network integrated judgment. (2) Collect the acute cerebral infarction patients with phlegm heat and bowel excess. Apply the evaluation the two time points of TCM syndromes.The acute phase of cerebral infarction patients were randomly divided into Xing Lou Chen Qi decoction treatment group and routine western medicine as the control group. Gather the information of two points on bowel excess and after relieving bowel excess (whole stage is in 7 days). Main measurements include:general signs, scales, platelet, the laser speckle imaging blood flow index. Based on stroke phlegm heat and bowel excess relieving in correlation analysis of questionnaire, and the BP artificial neural network model is established and from phlegm heat relieving assessment for stroke disease.[Result]:Results of frequency analysis results (1) from the TCM syndrome factors, the total of eight syndrome elements include:phelgm 69 times, stasis 56 times, wind 38 times,20 times qi deficiency, heat 19 times,10 times Yin deficiency, bowel excess 10 times,2 times wet. In the three stages, "phlegm+heat+bowel excess" appears 10 times, which appear in the acute phase of cerebral infarction phlegm heat and bowel excess six times, appeared four times during the recovery period, the sequelae stage appear 0 times. In the "stroke attack on meridians’" coagulation detection, A30 and CL30, LY30, A and CI, E, Angle with A. CI, E, G, MA, TPI, APTT and R, SP, TMA, LY30 and CL30, EPL. CI and E. G, TPI, TPI and E, A. Fib and D-dimer, A, Angle, CI, E, G, MA, TPI, G and A, E, TPI, INR and D-dimer, K and PMA, TMA, MA and A, CI, E, G, TPI, PLT and A, Angle, CI, E, Fib, G, MA, TPI, PT and D-dimer, INR, R and K, TMA, SP and R, TMA. There was a significant positive correlation between them. Angle with PMA, TMA, SP, R, A and PMA, A30, K and A, Angle, CI, E, G, MA, TPI, Fib. PLT, MA and PMA, R and CI, TPI, SP and CI, TPI, TMA and CI, Fib, TPI. There was a significant negative correlation between them. PMA and PLT, G, E, INR and SP. There is a good negative correlation between them. Western diagnose as "acute cerebral infarction":APTT and SP, TMA, R, PLT and CI, Angle, TPI, MA, G, E, A, Fib and A, MA, TPI, G, E, Angle, APTT, CI and A, E and, G, TPI, Angle, MA, Angle and TPI, A, G, E. MA. D-dimer and PT, INR, TMA and K, R, K and PMA, between the TPI and the A, G, E, MA, G and A, E, MA, E and A, A30 and CL30, MA and E, A, EPL and LY30, SP and R, PT and INR, There was a significant positive correlation between them. K and Angle, CI, MA, TPI, A, G, E, PLT, Fib, CI and R, SP, PMA. TMA and Angle, TPI, PMA and MA, A, Angle, R and Angle. Significantly between negative correlations was found. Fib and PLT, CI there is a good positive correlation between them. PMA and G, E, PLT, Fib and TMA, SP and Angle, D-dimer, TPI, R and TPI, D-dimer. There is a good negative correlation between them. Western diagnosis as "Cerebral Infarction recovery stage" Angle and A, G, E, MA, TPI, CI, Fib and D-dimer, PLT, A, MA, TPI, G, E, PLT and MA, A, G, E, CI and G, E, A, MA, TPI, MA and TPI, G, E, A, K and SP, R, TMA, A30 and LY30, CL30, EPL and A30, CL30, LY30, CL30 and LY30, TPI and A, G, E. G and A, E, E and A, SP and R, PT and INR, there is a significant positive correlation between them. K and Angle, CI, TPI, MA, G, E, CI and R, SP, Angle and TMA, R, SP, A and LY30, A30, EPL, there is a significant negative correlation between them. TMA and APTT, SP, R, Fib and CI, Angle, PLT and TPI there is a good positive correlation between them. K and A, Fib, TMA and CI, TPI, R and TPI, INR, PT, SP and TPI, INR, PLT and EPL, PLT, there is a good negative correlation between them. Western diagnosis as "sequelae of cerebral infarction":A30 and CL30, LY30, Angle and CI, CL30 and LY30, E and A, TPI, EPL and A30, CL30, LY30, Fib and A30, CL30, EPL, LY30, G and A, E, TPI, TPI and A, CI, MA and A, E, G, TPI, PT and INR, there are significant positive correlations between them.K and A, TPI, There was a significant negative correlation between them. A and CI, Angle and TPI, D-dimer and CI, TPI, INR, PT, CI and G, E, K and A30, there is a good positive correlation between them. TMA and D-dimer, PLT, CI and K, R, R and Angle.there is a good negative correlation between them. In BP artificial neural network of cerebral infarction, phlegm heat and bowel excess, wind-phlegm and stasis, phlegm-stasis in channels, Yin deficiency and wind act, has a relative high determine effectiveness. And wind-phlegm and stasis, blood stasis, Qi and Yin deficiency, phlegm-damp and Yin of liver and kidney deficiency has a relative high accuracy. (2) The PU value of Laser speckle imaging between bowel excess relieved and unrelieved groups showed that the relieved groups is higher. And in the correlation analysis, the high PU value in the part of hand has a significant positive correlation with the differential. And the low PU value in the part of hand with TMA, EPL, LY30 doesn’t have the significant correlations. Before and after treatment in stroke, in the symptoms and signs, the test group and control group in the language indicators and the total score had the significant differences; the test group of upper limb paralysis, refers to paralysis and toe paralysis, there are significant differences, while the control group showed no difference in these items. Changes in ischemic Syndrome syndrome elements, the test group and the control group in the wind, fire, phlegm three indicators are significant differences exist. Regardless of changes before and after the test group and control group indexes were not significantly different. In the stroke phlegm heat and bowel excess scale changes, two of the main syndrome, minor syndrome index showed that there were significant differences, and the total score was also significantly different.2 times NIHSS scale evaluation between the test group and the control group were significantly different. These four scales were no significant differences between the test and control groups. The prediction error of training and testing were small.[Conclusion]:(1) pathological changes appered in each phase of stroke, the internal elements of syndromes diverse and have different combinations, but phlegm, blood stasis, wind, Qi deficiency, heat, Yin deficiency and wet throughout the stroke and inner parts and the whole, phlegm heat and bowel excess showed obvious dynamic change characteristics of the acute phase of cerebral infarction phlegm heat and bowel excess appeared most in convalescence has decreased, disappeared in sequelae period.And the stroke syndrome elements in different periods of weight and the hemodynamic characteristics of closely linked, in the dynamic balance of coagulation and fibrinolysis system, acute phase of cerebral infarction, during the with clotting of blood, the formation of related parameters has the big changes and formate amount of correlations of clotting. The correlation of fibrinolytic function is relatively little, which we though it might because the high coagulation state has the close relation with wind heat and stasis poison mixed each other.Patients with cerebral infarction convalescence showed the opposite relation between the strength of clot with the portion of fibrinolytic. The process of blood clots forming process gradually become stable and result from the heat syndrome reduce. Fibrinolytic process shows the integrate connection, and fibrinogen in the stage of fibrinolytic plays an important role, the number of parameters rise up in the fibrinolytic phase. Comprehensive analysis indicated that coagulation and fibrinolysis play an equal role in the state of cerebral infarction sequela, the body’s Qi and blood goes smoothly and stablely. Neural network has a certain comprehensive judgment, of which the wind phlegm and blood stasis is more accurate and correct. (2) Xing Lou Chen Qi decoction treatment has obvious effect to the improvement of the limb function. Conventional treatment has obvious effect on the improvement of the language, for endogenous wind, fire, phlegm wet has the significant changes before and after the treatment, at the same time to the improvement of the phlegm heat and bowel excess, especially to relieving the bowel excess. Xing Lou Chen Qi decoction treatment and the Conventional treatment both can relieve the bowel excess in the same effect, but the Xing Lou Chen Qi decoction treatment can improve human body function at the same time, the organ and Qi and blood function, as well as the limbs function can recover comprehensively, which made the basis. Establish the model after the screening to syndrome scale score for the input and output of BP artificial neural network model, applied the ischemic syndromes diagnostic scale part parameters to evalue the whole value of the stroke with phlegm heat and bowel excess scale. As a guidance for diagnose the syndrome of phlegm heat and bowel excess, thus to achieve early clinical observation and intervention, which has positive significance. After the laser speckle exploratory observation of blood flow imaging, we concluded that defecate can increase the blood flow by pushing the Qi through relieving the bowel excess, and to improve the moving of blood. Also, establish the artificial neural network model can help clinical doctors for prediction of syndromes.