Prognosis And Prognostic Factors For Aphasia After Intravenous Thrombolysis In Patients Post Cerebral Infarction Receiving Acupuncture Combined Therapy

Objectives1.To study general facts of aphasia patients after intravenous thrombolysis for cerebral infarction from various aspects,including patient basic situation,treatment,symptom improvement,adverse complication,and burden of hospitalization.2.To examine the correlation between different influencing factors,including TCM syndrome type,solar term,etc.,and the prognosis aphasia patients after intravenous thrombolysis for cerebral infarction with acupuncture treatment.Methods:This research is a retrospective study based on prior clinical diagnosis and treatment cases.The subjects are inpatients with aphasia after cerebral infarction and had undergone intravenous thrombolysis after onset and received comprehensive acupuncture treatment in the Acupuncture Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from September 1,2018,to September 31,2020.By sorting out basic situations,treatment measures,symptom improvements,adverse complications,and other information from patient medical histories,it leveraged SPSS21.0 software to apply rank-sum test or chi-square test on classified data and used exposure factors as covariates to establish a logistics regression model for statistical analysis so as to study the basic characteristics of the entire community of aphasia patients after intravenous thrombolysis for cerebral infarction,and to discuss the prognosis of aphasia patients after intravenous thrombolysis for cerebral infarction and its influencing factors in terms of improvement of language function,the occurrence of PSD and length of hospital stay.Results:1.This study includes a total of 700 patients,with an average age of 54.5 years and more male than female.Most of them had a history of smoking,while less than half of them had a history of drinking.Hypertension accounted for the most in history medical records,followed4by diabetes,coronary heart disease,and atrial fibrillation.The proportion of medium stroke was the highest among all,followed by light stroke.Severe stroke only took 2.0%,mainly in the non-acute stage,with few patients with PSD.In descending order of distribution,TCM syndrome types were yin-deficiency syndrome,qi-deficiency blood-stasis syndrome,wind-phlegm blocking collateral syndrome,liver-yang Bao-kang syndrome,and phlegm-heat viscera demonstration.Chu Shu(End of Heat),Bia Lu(White Dew),Han Lu(Cold Dew),Mang Zhong(Grain in Ear)were four solar terms with the highest frequencies of stroke onset.During the treatment period,the improvement rates of language function,limb muscle strength,and NIHSS scores were 62%,33.4%,and 48.7% respectively.As for complications,pulmonary infection accounted for 8.9% of the total population;urinary tract infection accounted for 3.8%;post-stroke depression accounted for 4.1%.In terms of hospitalization burden,the longest hospitalization time was 84 days;the shortest was 7 days;the average hospitalization time was 17.6 days.2.The influencing factors for the improvement of language function in patients with aphasia after intravenous thrombolysis for cerebral infarction may include previous hypertension,previous atrial fibrillation,moderate stroke,severe stroke,pulmonary infection,and elevated plasma d-dimer level.The effect of onset solar terms and periods of acupuncture intervention on the improvement of language function has not yet been confirmed.Patients with no drinking history are less likely to develop PSD.However,the correlation between acupuncture intervention and PSD in the acute period has not been confirmed either.No factors related to prolonged hospitalization of patients with aphasia after intravenous thrombolysis for cerebral infarction were found.Conclusion1.Most of the patients with aphasia after intravenous thrombolysis for cerebral infarction were admitted to the hospital in a non-acute stage.The severity of the disease is mostly mild and moderate stroke,most of which were not accompanied by pulmonary infection,urinary tract infection,and post-stroke depression,with a relatively stable condition.The patients were mainly elderly and male.Most of the patients had bad living habits such as smoking and drinking,and the proportion of hypertension and diabetes is very high.We should be alert to the occurrence of cardiovascular disease and the recurrence of cerebrovascular disease.2.The TCM syndrome types of aphasia after intravenous thrombolysis of cerebral infarction in our hospital were as follows in descending order of distribution: Yin-deficiency wind-moving syndrome,qi-deficiency blood-stasis syndrome,wind-phlegm blocking collaterals syndrome,hyperactivity of liver-yang syndrome,and excess of phlegm-heat and fu-organ syndrome.The history of drinking,the location of the lesion,and the history of diabetes may be the influencing factors of the distribution of TCM syndrome types in aphasia patients after venous thrombolysis.3.No correlation was found between the period of acupuncture intervention,the solar term of onset,the improvement of language function,and the length of hospital stay.4.No correlation was found between the period of acupuncture intervention and the occurrence of PSD in patients with aphasia after intravenous thrombolysis for cerebral infarction.5.The solar term of onset may be related to the improvement of muscle strength and neurological function in aphasia patients after intravenous thrombolysis.