| Objective(1).To study the dynamic evolution of zheng with patients of aneurysmal subarachnoid hemorrhage in perioperative period.(2).To analysis the relationship between Traditional Chinese Medicine zheng at different times in perioperative period and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.And the effect of Traditional Chinese Medicine zheng on mRS score at discharge.(3).To comprehensive assess the influencing factors for cerebral vasospasm.(4).To evaluate the factors that influence mRS score at discharge to provide a reference for clinical improvement of prognosis.MethodsRetrospective observation research.821 continuous patients were diagnosised aneurysmal subarachnoid hemorrhage or intracranial aneurysm surgery in Guangdong Province Hospital of Traditional Chinese Medical from January 2008 to December 2014.And 257 patients were included in our research.Zheng was classified into five phases:preoperative,postoperative day 1,postoperative day 3,postoperative day 7,postoperative day 14,and to discuss the dynamic evolution of zheng of five phases in perioperative period from yang syndrome and yin syndrome and subgroup analysis,as well as the relation between Traditional Chinese Medicine zheng and the period of cerebral vasospasm and mRS score at discharge with univariate test.We established two models with adjusting different factors to respectively discuss the effect of Traditional Chinese Medicine zheng on cerebral vasospasm,and the correlation of Traditional Chinese Medicine zheng and syndrome transformation in perioperative period with mRS score at discharge.Variable were collected as below:age and sex,medical history,clinical grades on admission,radiographic grades status on CT,the size and position of aneurysm,operation mode,external-ventricle drainage and vasoactive medication,and were analyzed with univariate and non-conditional logistic regression stepwise analysis to find the relation among variables,cerebral vasospasm and prognosis of the Chinese population with aneurysmal subarachnoid hemorrhage in perioperative period through a multiple-center retrospective observation research.Results(1)The phases zheng of Traditional Chinese Medicine syndromes were distinctly distributed in different perioperative period of subarachnoid hemorrhag.In the first phases of preoperative,postoperative dayl,postoperative day 3,the zheng of yang syndrome and fire,heat,fu-Organ sthenia syndrome were the main factors,and the main performance was syndrome of Wind-Fire and Invading Upward,Phlegm-Heat Blocking Internally,and Dyspeptic Food Intermingled With Phlegm Blockade which belong to sthenia syndrome of yang syndrome.Fire and heat was gradually decreased,and phlegm increased at postoperative day 7.The ratio of zheng of yang syndrome was close to zheng of yin syndrome(48.60%vs 51.40%);At postoperative day 14,syndrome of wind and phlegm increased more,syndrome of fire and heat were more pronounced downward trend.The main factor was zheng of yin syndrome,and the main performance was syndrome of Wind-Phlegm Invading Collaterals which belongs to sthenia syndrome of yin syndrome.While transformation between yin and yang syndrome,the main performance was transform from yang syndrome to yang syndrome of 105 patients(40.9%),the second was the transformation of yin to yang syndrome and yang to yin syndrome which were the same patients of 72(28.0%).As transformation between sthenia and deficiency syndrome,the main performance was transform from sthenia syndrome of yang syndrome to sthenia syndrome of yang syndrome of 100 patients(38.9%),the second was the transformation of sthenia syndrome of yin syndrome to sthenia syndrome of yin syndrome and sthenia syndrome of yang syndrome to sthenia syndrome of yin syndrome which were the same patients of 61(23.7%).(2)Assess the zheng of Traditional Chinese Medicine syndromes at difference phases in perioperative period influence on cerebral vasospasm,the results showed that if the patient performed of yin syndrome in postoperative day 3,the possibility of combined with cerebral vasospasm was smaller than yang syndrome.(3)The correlation between Traditional Chinese Medicine zheng and prognosis,the results showed that if the patient performed of deficiency syndrome of yin syndrome at postoperative day 1 and day 3,or orifices confused by phlegm syndrome,Phlegm-Heat Blocking Internally at postoperative day 7,it might be a sign of poor prognosis.In the course of disease dynamic change,the patients were converted from sthenia syndrome of yin syndrome to deficiency syndrome of yin syndrome,which was a sign of poor prognosis.(4)Different risk of cerebral vasospasm with different gender patients.The occurrence of cerebral vasospasm on men was 2.75 times higher than women(95%CI:1.44-5.27).The operation mode of interventional embolization was a protective fator for cerebral vasospasm.The risk of cerebral vasospasm with interventional embolization therapy of aneurysm was 0.14 fold compared to with craniotomy clipping surgery(95%CI:0.07-0.28).There were no statistically significant among other variables such as:age,sex,clinical grades on admission and cerebral vasospasm groups.(5)Assess factors influence on prognosis with univariate test and non-conditional logistic regression stepwise analysis,patients with a GCS score of 7 or more at admission had a better prognosis at discharge than with a GCS score less 7(OR:0.29,95%CI:0.13-0.68).The use of papaverine during hospitalization was a protective factor for the prognosis.Papaverine was associated with a poor prognosis in 0.41-fold of unused papaverine(95%CI:0.21-0.79).And brain CT with intraventricular hemorrhage was s a risk factor for prognosis,and its poor prognosis was not associated with intraventricular hemorrhage patients 4.48 times(95%CI:2.35-8.53).Conclusion(1)Preoperative Traditional Chinese Medicine zheng syndrome was mainly evil,after operation the evil gradually faded,and vital qi became weak,but the evil was relatively more positive than gradually declined vital qi,which was still dominated,so the intervention of operation itself had no significant effect on the evolution of Traditional Chinese Medicine zheng syndrome,and the perioperative period was still dominated by pathogenic excess.After onset of aneurysmal subarachnoid hemorrhage,in the first phases of preoperative,preoperative,and postoperative 1-3 days,postoperative day1,postoperative day 3,the zheng of yang syndrome and fire,heat,fu-organ sthenia syndrome were the main factors,and the main performance was sthenia syndrome of yang syndrome.Fire and heat was gradually decreased,and phlegm increased at postoperative day 7.The ratio of zheng of yang syndrome was close to zheng of yin syndrome;At postoperative day 14,syndrome of wind and phlegm increased more,syndrome of fire and heat were more pronounced downward trend.The main factor was zheng of yin syndrome,and the main performance was syndrome of Wind-Phlegm Invading Collaterals which belongs to sthenia syndrome of yin syndrome.Perioperative period should be based on the actual situation,with the zheng to adjust the treatment.(2)If patients appeared to yin syndrome at postoperative day 3,the possibility of occurrence of cerebral vasospasm was smaller than yang syndrome,it was more beneficial to patients with clearing heart fire,claming liver fire,clearing heat to purgate and resuscitation.(3)As the correlation of Traditional Chinese Medicine zheng and prognosis,on the one hand we need to recognize,if the patient performed of deficiency syndrome of yin syndrome at postoperative day 1 and day 3,or orifices confused by phlegm syndrome,Phlegm-Heat Blocking Internally at postoperative day 7,it might be a sign of poor prognosis.In the course of disease dynamic change,the patients were converted from sthenia syndrome of yin syndrome to deficiency syndrome of yin syndrome,which was a sign of poor prognosis.On the other hand,we should take the appropriate treatment,such as patients appeared with orifices confused by phlegm or phlegm-heat blocking internally at postoperative day 7,resolving phlegm and resuscitation,or phlegm resuscitation might be the appropriate treatment.(4)Male with aneurysmal subarachnoid hemorrhage needed to pay more attention to prevent cerebral vasospasm than female.And the operation mode of interventional embolization was recommended to prevent mechanical damage with craniotomy clipping secondary to cerebral vasospasm dealing with aneurysm.(5)Patients with a GCS score of less than 7 on admission should receive more attention and be aware of changes in the condition at any given time.The use of papaverine during hospitalization might be of benefit to patients with a higher risk of neurological deficits when brain CT was associated with intraventricular hemorrhage. |
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