Clinical Study Of Combining TCM And Western Medicine To Treat ASAH

ObjectiveTo learn the role of TCM during treating aSAH, and key treatment point, then explain the aSAH medical theory and mechanism by TCM, to regulate and promote the use of TCM to benefit patients.Methods1 By selected cases by age, sex, time of onset, disease characteristics, admission CT and HUNTHESS grade and combined symptoms, aneurysm imaging features, surgical procedures, postoperative complications, Chinese medicine treatment, and discharge GOS score, follow-up statistics on such cases and to describe the frequency distribution.2 systematic stratificate on the selected patients, divide into groups to learn the difference in various factors, the method of dividing groups refers to the road map.3 For all of the above prognostic factors in multiple regression statistical analysis whether the impact of various factors on the prognosis, and further analysis of the weights of various factors and the relationship between various factors.Results1 General InformationA total of 288 cases of patients,113 cases were male (39.2%) and females (60.8%), mean age 52.86±13.41 years old, mainly from Guangzhou, 117 cases (40.8%), Foshan,35 cases (12.2%), Dongguan,11 cases (3.8%), Shenzhen,9 cases (3.1%), Zhuhai 9 cases (3.1%), Jiangmen 5 cases (1.7%), Chaoshan 10 cases (3.5%), Qingyuan 10 cases (3.5%), other areas in Guangdong and other provinces 81 cases (28.2%). in which the age had significant effect on prognosis, discharge GOS score 1 to 5 ages were, respectively 50.25,54.44,57.31,63.80,60.59, GOS1 level has significant difference between grade 3,4,5, P<0.05. In the diagnostic category of yin and yang, gender has significant differences for yin, male 23 cases (8.68%), female 56 cases (21.13%), P<0.05.2 Past medical historyhypertension in 110 cases (38.2%), hyperlipidemia in 27 cases (9.4%), heart disease,15 cases (5.2%), cerebral infarction in 20 cases (6.9%), diabetes in 11 cases (3.8%), anemia 6 cases (2.1%), AVM 4 cases (1.4%), moyamoya 4 cases (1.4%), intracranial stenosis in 12 patients (4.2%), cervical spondylosis in 10 patients (3.5%).3 State before hospitalfirst symptom in 181 cases alone were headache (62.8%),63 cases of disturbance of consciousness (21.9%), hemiplegia in 13 cases (4.5%), dizziness onset in 8 cases (2.8%), ocular symptoms in 8 cases (2.8%), epilepsy in 3 cases (1%), other 12 cases (4.2%). CT grade 0 in 6 cases (2.6%), grade 1 in 130 cases (45.1%),2 Grade in 74 cases (25.7%),3 grade in 56 cases (19.4%),4 grade in 22 cases (7.6%). HUNT-HESS grade 1 in 94 cases (32.6%), grade 2 in 99 (34.4%), grade 3 in 55 cases (19.1%), grade 4 in 34 cases (11.8%). HUNT-HESS had significantly difference in the diagnostic category of yin and yang, The syndrome of Yang HUNT-HESS grade were few 2.31±1.05, the syndrome of Yin HUNT-HESS grade were 1.79±1.02, P<0.01. the syndrome of Yang CT grade class card mean 2.01±0.99, the syndrome of Yin CT grade class card mean 1.63±0.98, P> 0.05.4 Onset time characteristics24 Solar Terms:The Autumnal Equinox up,20 patients (3%), followed by cold dew,19 patients (2.9%), Winter begins 16 cases (2.4%), heavy snow in 15 cases (2.3%), Great cold in 13 cases (2%), between the time from the Autumn begins to the Great cold, and from the Spring begins to Stopping the heat, the former incidence of aSAH was significantly higher than the latter, P<0.05. compared 12 Heavenly Stems time, then found that Si Shi (morning)had the highest incidence of 33 cases,5%, followed by SHEN Shi (afternoon),29 cases, accounting for 4.4%, chenshi(breakfast time) 26 cases,4%, Youshi(sunfall) 24 cases, accounting for 3.6%, the lowest Yin Shi(dawn) 5 cases, accounting for 0.8%, Choushi(break) 6 cases,0.9%. Match to 12 meridians Flowing map the highest incidence of aSAH was found corresponding to the Foot Tai Yin Spleen Meridian and Foot Tai Yang bladder Meridian.5 Intracranial aneurysm characteristicsanterior communicating artery aneurysm in 78 patients (27.1%), left posterior communicating artery aneurysm 39 cases (13.5%), right posterior communicating artery aneurysm in 30 cases (10.4%), left anterior cerebral artery 5 cases (1.7%), right anterior cerebral artery aneurysms in 6 cases (2.1%), the left middle cerebral artery aneurysm in 21 cases (7.3%), right middle cerebral artery aneurysm in 24 patients (8.3%), the left brain artery aneurysm in 1 case (0.3%), Right middle cerebral artery aneurysm in 2 cases (0.7%), basilar artery in 18 cases (6.3%), left vertebral artery aneurysm in 10 patients (3.5%), right vertebral artery aneurysm in 7 cases (2.4%), left common carotid within the aneurysm in 20 cases (6.9%), right carotid artery of 27 cases (9.4%). Aneurysms distribution had a significant effect on TCM syndrome, the anterior communicating artery, bilateral posterior communicating artery, bilateral middle cerebral artery and the basilar artery is basically Syndrome of wind, fire, phlegm, closed blocking, P<0.05. In the bilateral vertebral artery and internal carotid artery was not significant. Intracranial aneurysms locate in which hemisphere had no significant difference for the syndrome. Aneurysm diameter and neck width is significant impact on the prognosis, death of patients had an average aneurysm diameter of 8.49mm, neck width of 4.41mm, compare discharge GOS score 4 or 5 level, which is significantly larger, P<0.05. mostly ruptured aneurysms'diameter between 3.9～4.2mm (13.5%), most below to 5.2mm for width of neck, mostly between 2.8 and 3.2 mm. Which meet the wide-necked aneurysms were 113 cases, up by 39.2%, this group was 83.3% for the single aneurysm,13.5% for the two aneurysms,6 patients presented with three aneurysms, there is one case of 6 aneurysms in 1 patient. The number of aneurysms had no significant effect on prognosis, but there is significant effect on the follow-up results, P<0.05.6 Efficacy difference of treatmentssimple coil packing technique in 106 patients (38.5%), balloon-assisted coil embolization in 49 cases (17.8%), stent assisted coil embolization in 16 cases (5.8%), wing point approach craniotomy clipping surgery,66 cases (24%), parent artery occlusion in 4 cases (1.5%), liquid glue aneurysm embolization in 3 cases (1.1%), balloon angioplasty combined with stent assisted coil embolization 2 cases, double catheter assisted coil embolization and stent aneurysm embolization in 1 case, with total cerebral angiography without surgical in 27 cases (19.8%). Complete embolization was 203 cases (82.2%), and partial embolization in 44 cases (17.8%). Intraoperative CVS occurred in 15 cases (6%), aneurysm rupture in 19 patients (7.6%), coil shift but the blood flow no effect in 18 cases (7.2%), ischemia caused by coil shift in 6 cases (1.6%), thrombosis in 3 patients (1.2%), CCF in 1 patient (0.4%). surgical option on the prognosis of no significant difference in effect, However, embolization, and craniotomy with aneurysm clipping operation had significant difference in the incidence of aneurysm rupture, the incidence of embolization was significantly lower than craniotomy clipping surgery, P<0.05, and the same to follow-up results. the use of balloon-assisted, craniotomy clipping surgery and onyx liquid glue, parent artery occlusion to obtain a higher degree of complete embolization, P<0.05, at the same time, the incidence of postoperative cerebral infarction and DCVS significantly higher than in partial embolization group, P<0.05. Embolization and craniotomy clipping have differences on the occurrence of postoperative complications DCVS, interventional group lower than craniotomy clipping group, P<0.05. Intraoperative aneurysm rupture impacted on postoperative bleeding and the occurrence of epilepsy and the CVS took place in operation raised the incidence of gastrointestinal bleeding, intraoperative coil displacement on the incidence of urinary tract infections have a significant effect, P<0.05. Intraoperative complications, no significant effected on prognosis, but the pulmonary infection and cerebral infarction after operation impacted on the prognosis, which had significantly different, P<0.01. Chinese medicine treatment can significantly improve the prognosis, P<0.05, T-W medicine group, the incidence of gastrointestinal bleeding and pulmonary infection in the postoperative were significantly lower than that of WM group, P<0.05.Conclusion1 aSAH mostly happened on women. Men and women, there were significant difference in the diagnosis of yin and yang, women were apt to yin. the average age of onset is about 50 years, age had significant effect on the prognosis, the older had the worse prognosis. 2 State before hospital affected the yin or yang syndrome, Yang syndrome had significantly higher HUNT-HESS and CT scores than the yin syndrome, and the incidence of aSAH was majority to Yang syndrome.3 Wind, cold, dry evil can lead to increased incidence of aSAH significantly. Fatigue and stress are important predisposing factors to aSAH. At the same time, match to the 12 meridians flowing map, corresponding to the peak incidence of Foot Tai Yin Spleen Meridian and the Foot Tai Yang bladder Meridian. blood flourishes in Si Shi, the weakness wall at the vessel may be vulnerable to shocks resulting in bleeding. It is easy to produce disease of the bladder Meridian in You Shi, whose characteristics are similar to aSAH symptoms, so we can use pinprick or herbs to the bladder Meridian in order to treat aSAH. the bladder Meridian is outside, and the Kidney Meridian is inside, "preventive treatment of disease" is encouraged, so nourish Kidney Meridian can prevent disease of the bladder Meridian. " Nourish Kidney and Liver Yin" rule can be used throughout the whole process of conservative observation for unruptured aneurysm.4 The distribution of intracranial aneurysms affected diagnostic of yin and yang syndrome, anterior communicating artery, bilateral posterior communicating artery, bilateral middle cerebral artery and basilar artery basically belong to syndrome of wind, fire, phlegm, closed blocking.Aneurysm diameter and neck width significantly affects the prognosis, the larger diameter, the wider neck, the worse prognosis. Surgical options, the number of intracranial aneurysms and the degree of embolization or clipping effect on follow-up results and prognosis. of intervention significantly reduced the rupture of aneurysms than clipping, by means of balloon-assisted and craniotomy clipping can significantly improve the degree of embolism, but increase DCVS and secondary cerebral infarction. Intraoperative complications increase the postoperative complications.5 Use of TCM combined western medicine can improve the prognosis, reduce the production of postoperative complications, especially pneumonia and gastrointestinal bleeding.