| Background:Ischemic stroke is a common neurological disease with poor prognosis.A considerable number of patients may experience neurological deficits such as hemiplegia,aphasia,varying degrees of loss of labor ability,and depression,which brings a heavy psychological burden to patients.Secondary prevention can effectively reduce the occurrence of adverse prognosis in this disease,but there are still significant residual risks associated with persistent medication.Therefore,it is urgent to explore safe and effective traditional Chinese medicine prevention and treatment methods.Based on the physiological and pathological relationship between the five organs and the brain,Director Yang Baolin proposed that ischemic stroke is located in the brain and is related to the five organs.The pathogenesis is centered around the disharmony of the five organs,with deficiency of qi,blood,yin and yang as the foundation,and blockage of the brain meridians by deficiency,phlegm,stasis,fire,and toxin as the criteria.The treatment is guided by the principle of "treating the whole body to heal the local area,regulating the five organs to nourish the brain and marrow",and is planned to be treated with the addition or subtraction of the Hezhong Yinao Prescription according to clinical symptoms.This formula takes the meaning of the classic formula and combines the methods of tonifying qi and nourishing blood,regulating qi mechanisms,and resolving phlegm and unblocking collaterals,with the aim of warming,nourishing,and regulating the middle energizer,in order to replenish the qi and blood of the five organs,and smooth the flow of the five organs’ qi mechanisms,so as to make the brain meridians full and clear,and the brain spirit fluent as usual.Objective:To retrospectively analyze case data and follow-up information from Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine,explore the effectiveness of Hezhong Yinao Prescription in preventing and treating ischemic stroke using a single group experimental target value method,observe the correlation between medical history,risk factors,traditional Chinese medicine syndrome characteristics,and the use of Chinese and Western medicine with clinical adverse prognosis,aiming to provide effective prevention and treatment ideas and measures from the perspective of traditional Chinese medicine for clinical treatment of this disease.Method:This study is a retrospective study,using a single group experiment combined with target value method to evaluate the preventive and therapeutic effects of Hezhong Yinao Prescription on ischemic stroke.The study subjects were patients who visited Dongzhimen Brain Disease Department of Beijing University of Traditional Chinese Medicine from August 2015 to March 2018,and all case data must meet the diagnostic criteria for acute ischemic stroke or transient ischemic attack.Utilizing the SQL server database of the Dongzhimen Hospital Information Center of Beijing University of Traditional Chinese Medicine,fuzzy retrieval of case information that meets diagnostic criteria,precise retrieval of traditional Chinese medicine prescription information that meets treatment plans,importing Excel software,and further processing the data based on inclusion and exclusion criteria,extracting information such as the patient’s age,gender,medical history,personal history,traditional Chinese medicine syndrome elements,and traditional Chinese and Western medicine diagnosis,Follow up the patient’s prognosis and medication use within 5 years by phone.The observation indicators include basic information,including age,ethnicity,gender,onset time,admission time,discharge time,etc.History and risk factors,including stroke/TIA,CHD/myocardial infarction,hypertension,diabetes,dyslipidemia,atrial fibrillation,carotid stenosis,obstructive sleep apnea syndrome,hype homocysteine,hyperuricemia,smoking,drinking,obesity,etc;There are elements of traditional Chinese medicine syndrome,including blood stasis syndrome,qi deficiency syndrome,phlegm dampness syndrome,wind syndrome,yin deficiency syndrome,fire heat syndrome,etc.There are combinations of syndrome elements,including single factor,two syndrome elements,three syndrome elements,four syndrome elements,etc.,as well as combinations of deficiency and excess,including pure deficiency syndrome,pure excess syndrome,and mixed deficiency and excess syndrome;There are also cases of taking traditional Chinese and Western medicine,including taking traditional Chinese medicine from the acute stage to the recovery stage,adhering to or not adhering to traditional Chinese medicine,and whether to comply with modern secondary preventive medicine.The efficacy indicators include primary evaluation indicators,including stroke recurrence,and secondary evaluation indicators,including myocardial infarction and all-cause death.Use SPSS 26.0 software to conduct statistical analysis on the data,select the data published by CNSR-Ⅲ as the target value,use chi square test or precise probability method for hypothesis testing in efficacy evaluation,and compare the confidence interval calculation method with the target value;Single factor analysis and binary logistic regression were used to analyze the correlation between adverse prognosis and general information,medical history and risk factors,traditional Chinese medicine syndrome elements,and the use of traditional Chinese and Western medicine.Result:① After screening the case data,a total of 1565 patients were diagnosed with ischemic stroke,with 65.75%of males and 34.25%of females.There were more males than females,and there was a significant difference in age distribution between males and females(P<0.01).The overall age of onset was more common in the middle-aged and elderly group,and the gender age distribution showed that males were more common between 55 and 69 years old,while females were more common between 75 and 84 years old.Hypertension accounted for 80.45%,dyslipidemia 56.04%,smoking 45.56%,diabetes 43.77%,and alcohol 40.19%of the patients with high disease history and high frequency of risk factors.The frequency of occurrence of traditional Chinese medicine syndrome elements is relatively high,with Qi deficiency accounting for 70.22%,phlegm dampness accounting for 69.58%,and blood stasis accounting for 61.73%.The combination of syndrome elements is most common,with the combination of two and three syndrome elements accounting for 34.12%and 19.36%,respectively.The combination of syndrome elements with deficiency and excess is mainly composed of deficiency and excess,accounting for 69.65%.After strict screening,173 cases were ultimately included,including 3 cases of dropout.The dropout did not participate in subsequent efficacy and correlation analysis.Among the included case data,males accounted for 58.96%and females accounted for 41.04%.The overall age of onset was more common in the middle-aged and elderly group,and the gender age distribution showed that males were more common between the ages of 50-69 and females were more common between the ages of 65-84.Hypertension accounted for 75.14%,dyslipidemia accounted for 56.07%,diabetes accounted for 45.09%,and smoking accounted for 41.62%.The frequency of occurrence of TCM syndrome elements is relatively high,with Qi deficiency accounting for 65.32%,phlegm dampness accounting for 73.99%,and blood stasis accounting for 58.38%.The combination of syndrome elements is most common,with the combination of two and three syndrome elements accounting for 38.73%and 36.99%,respectively.The combination of deficiency and excess is mainly composed of deficiency and excess,accounting for 65.90%.Demography data show that the disease tends to occur over the age of 50,men are more prone to disease than women,and the age distribution of male patients is younger than that of female patients;The main risk factors were hypertension,hyperlipidemia,diabetes,smoking,drinking,etc;In terms of traditional Chinese medicine syndrome elements,ischemic stroke is commonly characterized by Qi deficiency syndrome,phlegm dampness syndrome,and blood stasis syndrome.The combination of syndrome elements is often complex,mainly with a mixture of deficiency and excess Among the 170 patients,there were 20 cases of stroke recurrence,accounting for 11.76%.Among them,there were 6 cases of recurrence within one year,with a recurrence rate of 3.53%.The upper limit of the confidence interval was 6.33%,which was lower than the target value of 9.71%.There was a statistically significant difference between the two groups(P<0.01).There were 3 6 deaths or myocardial infarction due to all causes,accounting for 21.18%.Among them,there were 6 deaths within one year,with an incidence rate of 3.53%.The upper limit of the confidence interval was 6.33%,which was higher than the target value of 3.71%,and there was no statistically significant difference between the two groups(P>0.05).The efficacy evaluation suggests that the use of Hezhong Yinao Prescription after admission and the addition or subtraction of Hezhong Yinao Prescription have a significant therapeutic effect on reducing the incidence of adverse prognosis in ischemic stroke patients within one year Univariate factors related to poor prognosis include age,smoking,adherence to secondary preventive medication,and adherence to traditional Chinese medicine(P<0.05);Single factor factors related to stroke recurrence include sleep apnea syndrome and adherence to traditional Chinese medicine(P<0.05);The single factors related to all cause death include age,adherence to secondary preventive medication,and adherence to traditional Chinese medicine(P<0.05);Further binary logistic regression revealed that age and adherence to traditional Chinese medicine were independent imaging factors for poor prognosis(P<0.05),age was a risk factor,and adherence to traditional Chinese medicine was a protective factor.Correlation analysis suggests that persisting in taking and using the Hezhong Yinao Prescription until the doctor instructs to stop the medication or consciously improves has a significant positive impact on the prognosis of the disease.Conclusion:Ischemic stroke is more common in the elderly,and it is more common in males than females,with a lower onset age.Traditional Chinese medicine syndrome elements are more common,such as qi deficiency,phlegm dampness,and blood stasis.The combination of syndrome elements is characterized by multiple factors and a mixture of deficiency and excess.In treatment,the characteristics of the elderly and the underlying pathogenesis of the disease should be combined,and the five organs should be adjusted to nourish the brain marrow and unblock the brain meridians.Combined with the efficacy evaluation and correlation analysis,it was confirmed that Hezhong Yinao Prescription could reduce the incidence of adverse prognosis of ischemic stroke,and the clinical significance of Hezhong Yinao Prescription in the prevention and treatment of ischemic stroke under the guidance of the concept of "treating the whole and improving the local area,regulating the five internal organs and nourishing the cerebral pulp" was preliminarily discussed. |
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