Analysis Of The Correlative Factors Affecting The Prognosis Of Patients With Massive Cerebral Infarction And The Distribution Characteristics Of Cerebral Blood Stasis Syndrome

Objective1.To investigate the factors affecting the mortality and severe disability rate of patients with massive cerebral infarction,in order to make early intervention and make the best clinical decision,to improve the prognosis.2.To investigate the distribution of cerebral blood stasis syndrome in patients with massive cerebral infarction,to provide new ideas for the diagnosis and treatment of traditional Chinese medicine.MethodsA retrospective analysis was performed on the patients with massive cerebral infarction who were admitted to the Department of Neurology,Guangdong Provincial Hospital of Chinese Medicine from January 1,2013 to December 31,2016.The data of the cases were collected according to the admission records and imaging data:Demographic characteristics such as age and gender;risk factors,including hypertension,hyperlipidemia,diabetes,atrial fibrillation,coronary heart disease,history of cerebral infarction,smoking,etc.;admission vital signs,admission neurological function score(NIHSS score,GCS score),internal and external treatment regimens(intravenous thrombolysis,endovascular therapy,decompressive craniectomy,and penetrating therapy),complication,death during hospitalization,discharge mRS score;imaging data included CT and MRI(infarct hemisphere,infarct size,midline shift);TCM four diagnostic information.The mortality and severe disability rate of patients with massive cerebral infarction were evaluated by the death and the mRS score.Statistical analysis was performed using SPSS20.0 statistical software.To investigate the risk factors of mortality and severe disability in patients with massive cerebral infarction.At the same time,to analyze whether the distribution of TCM syndrome conform to the cerebral blood stasis syndrome.ResultsOne hundred and twenty-eight patients were enrolled(49.2%male,mean age 70 years)in our study.There were 20 patients died during hospitali-zation(15.6%),108 patients survival(84.4%).The in-hospital mortality was 15.6%.There were 41 patients(32.0%)with good prognosis(mRS score,4 points),87 patients(68.0%)with poor prognosis(mRS score>4 points).The severe disability rate was 68.0%.In the univariate logistic regression analysis,admission GCS score may be a risk factor for in-hospital mortality of patients with massive cerebral infarction.The lower the admission GCS score,the higher the mortality during hospitalization(OR=1.06,95%CI:1.00-1.11,P= 0.035).Age,hypertension,atrial fibrillation,disturbance of consciousness,admission NIHSS score and GCS score,midline shift over 10mm may be the risk factors for in-hospital mortality of patients with massive cerebral infarction.In the multivariate logistic regression analysis,there was no risk factors for in-hospital mortality of patients with massive cerebral infarction.Age(OR=1.06,95%CI:1.00-1.11,P=0.035),hypertension(OR=5.26,95%CI:1.45-19.02,P=0.011)and using of osmotic drugs(OR=4.01,95%CI:1.03-15.66,P=0.046)were important risk factors for severe disability rate(mRS score>4).The older the age,the worse the prognosis.Patients with a history of hypertension had worse neurological outcomes.The prognosis of neurological function was worse in patients who received the osmotic drug.In the one hundred and twenty-eight patients,there were 23 patients(18.0%)not in conjunction with physical examination,so that the tongue was unavailable to dialectical.In the 105 patients with complete clinical data,there were 86 patients(81.9%)according with cerebral blood stasis syndrome,and there were 19 patients(18.1%)not.In our study,the proportion of patients with massive cerebral infarction according with cerebral blood stasis syndrome was 81.9%.There was no statistically significant difference in mortality and severe disability rate between patients whether according with cerebral blood stasis syndrome or not.ConclusionsPatients with massive cerebral infarction had high in-hospital mortality and severe disability rate.Age,history of hypertension,and using of osmotic drugs were important risk factors for massive cerebral infarction.The older the age,the history of hypertension,and the using of osmotic drugs,the worse the neurological function.In our study,the proportion of patients with massive cerebral infarction according with cerebral blood stasis syndrome was 81.9%.There was no correlation between in-hospital mortality?severe disability rate and cerebral blood stasis syndrome.It can be considered that the vast majority of patients with massive cerebral infarction according with cerebral blood stasis syndrome.