Analysis Of Factors Influencing Short-term Prognosis Of Acute Ischemic Stroke And Medication Rule

Objective:Through retrospective observation of patients with acute ischemic stroke,taking short-term prognosis at discharge as the entry point,the clinical data of patients with good prognosis and poor prognosis group were compared,and the factors influencing the short-term prognosis of patients with acute ischemic stroke treated by TCM were analyzed,so as to guide clinical practice and improve the efficacy of TCM.Data analysis technology was used to analyze the medication rules of Chinese medicine in the treatment of acute ischemic stroke,grasp the characteristics of clinical medication,and further guide the clinical diagnosis and treatment of Chinese medicine in the treatment of acute ischemic stroke.Methods:1 Analysis of influencing factors on short-term prognosis of acute ischemic stroke118 inpatients with acute cerebral infarction as the first diagnosis were retrospectively observed.Clinical data such as general data,laboratory serum indicators,National Institutes of Health Stroke Scale,modified Rankin Scale,Barthel index of assessment of activities of daily living,TOAST classification and TCM syndrome elements were collected,and the collected information was input into Excel tables to establish a database.SPSS 26.0 software was used for statistical analysis,and the influencing factors of prognosis of patients with acute ischemic stroke treated by TCM were screened out by binary Logistics regression analysis,and the performance of each influencing factor index in predicting the short-term prognosis of patients was evaluated by subject work characteristic curve analysis.2 Analysis of the medication rules of traditional Chinese medicine in the treatment of acute ischemic cerebral infarction based on data mining technologyTCM diagnosis,first prescription and other case information of 118 patients with acute ischemic stroke meeting the inclusion criteria were collected through the inpatient medical record system.The case information was input into Excel tables to establish a standardized database.Traditional Chinese Medicine Inheritance Support System(v2.5)was used to analyze the frequency of clinical medication and the rule of four properties and five tastes.Association rule analysis and entropy cluster analysis were used to analyze the rule of clinical prescription and summarize potential combinations of new prescriptions.Results:1 Analysis of influencing factors on short-term prognosis of acute ischemic strok1.1 A total of 118 patients were enrolled in this study,including 69 patients in the good prognosis group and 49 patients in the poor prognosis group,68 males and 50 females,with a median age of 70(64.25,82)years.The median age of the poor prognosis group was 77(68,84)years,which was significantly higher than that of the good prognosis group 69(63,79)years.The difference was statistically significant(p<0.05).20 patients with previous stroke history in the poor prognosis group were significantly higher than 14 patients in the good prognosis group(p<0.05).There was no significant difference in gender,history of hypertension,hyperlipidemia,diabetes,coronary heart disease,atrial fibrillation,alcoholism and smoking between the two groups(p>0.05).1.2 The average systolic blood pressure at admission in the good prognosis group was significantly lower than that in the poor prognosis group,and the difference between the two groups was statistically significant(p<0.05).There were no significant differences in other vital signs on admission,including temperature,pulse,respiration,and diastolic blood pressure,between the two groups(p>0.05).1.3 In the poor prognosis group,the main TOAST classification was large atherosclerotic infarction,with a total of 38 cases.In the good prognosis group,both large atherosclerotic infarction and cardiogenic embolism infarction were significantly less than those in the poor prognosis group,with statistical significance(p<0.05).The patients with higher NIHSS score and B1 score before treatment in the poor prognosis group were significantly higher than those in the good prognosis group,and the difference was statistically significant(p<0.05).A total of 22 patients received rt-PA intravenous thrombolytic therapy,and there was no significant difference between the good prognosis group and the poor prognosis group(p>0.05).1.4 In terms of serological tests,there were significant differences in WBC,NEUT,PLT,NLR,PLR,D-Dimer,FIB,ALB,ApoA1,HCY and other indicators between the poor prognosis group and the good prognosis group(p<0.05).There were no significant differences in LYMPH,CRP,APTT,ALT,AST,Cr,BUN,LA,LDL,HDL,CHO,TG,ApoB and other 13 serological indicators between the two groups(p>0.05).1.5 Among the 118 cases,104 cases were meridian-collateral stroke patients and 14 cases were zangfu stroke patients.The difference between the two groups was significant(p<0.05).The distribution of syndrome elements was mainly internal wind syndrome(95 cases),blood stasis syndrome(84 cases),phlegm dampness syndrome(81 cases),and Yin deficiency(the least).In the comparison between the poor prognosis group and the good prognosis group,the proportions of internal wind syndrome,qi deficiency syndrome,and Yin deficiency syndrome in the poor prognosis group were higher than those in the good prognosis group,and the proportions of internal fire syndrome,phlegm dampness syndrome,and blood stasis syndrome in the good prognosis group were higher than those in the poor prognosis group,but the differences were not statistically significant(p>0.05).1.6 The results of binary Logistics single factor regression analysis showed that age,previous stroke history,TOAST classification,systolic blood pressure,PLT,D-dimer,FIB,ALB,ApoA1,NIHSS score before treatment,BI score before treatment were related to the early prognosis outcome of Chinese medicine intervention(p<0.05).NEUT,WBC,PLR,HCY,NLR and TCM disease types had no significant correlation with prognosis(p>0.05).1.7 The results of binary Logistics multi-factor regression analysis showed that PLT,NIHSS score before treatment,ApoA1,TOAST classification and other factors were independent influence factors affecting the short-term prognosis of patients.1.8 ROC curve analysis showed that PLT,ApoA1,TOAST classification,NIHSS score before treatment and AUC of comprehensive indexes were 0.634,0.642,0.640,0.924 and 0.966,respectively.2 Analysis of the medication rules of traditional Chinese medicine in the treatment of acute ischemic cerebral infarction based on data mining technology2.1 Among all the subjects,the minimum age of male patients was 41 years old,the maximum age was 97 years old,and the average age was 69.37 years old.The minimum age of female patients was 52 years old,the maximum age was 92 years old,and the average age was 75.68 years old.The age of patients was mainly concentrated in the range of 61-90 years old,of which the patients aged 61-70 years old were the most.There are more male patients than female patients in most age groups,while there are more female patients than male patients in the 81-90 range.2.2 A total of 158 Chinese herbs were involved in 118 prescriptions,with a total frequency of 1512 herbs,including 35 high-frequency herbs.Among all the Chinese herbs,the top 10 most frequently used were red Peony root,Chuan xiong,Angelica sinensis,Pinellia pinellia,Licorice,peach kernel,safflower,Poria,Lumbricus and Astragalus.Among the 35 high-frequency herbs,there were 12 kinds of efficacy types of traditional Chinese medicine,and the frequency of tonifying deficiency drugs was the highest,accounting for 18.88%(206 times).The second was heat-clearing drugs and blood-activating and blood-stasis drugs.The use frequency of warm drugs was the highest,followed by cold drugs and peace drugs.The top three categories of the five flavor attributes from high to low were bitter,sweet and spicy.The top five most frequently used meridians were liver meridian,spleen meridian,heart meridian,stomach meridian and lung meridian.2.3 According to the analysis results of formula formulation,34 commonly used drug combinations were obtained,including 12 TCM.There are 23 combinations of TCM pairs,and the most commonly used pair is ligusticum Chuanxiong-Angelica;There were 9 combinations of 3 herbs and drugs,among which the combination of red peony root,ligusticum Chuanxiong and angelica sinensis was the most frequently used.There were two drug combinations of the four herbs,namely,Honghua-Red peony root-ligusticum Chuanxiong-peach kernel and Honghua-ligusticum Chuanxiong-peach kernel-Angelica sinensis.The results of drug association rule analysis showed that there were 15 drug combinations,including ligusticum Chuanxiong,Angelica sinensis,peach kernel,safflower,red peony root and lumbricus,etc.Based on the improved mutual information method,entropy cluster analysis was carried out,and 12 core clinical drug combinations and 6 new prescription combinations were obtained.They are anteline_mirabilite_Trichosanthes_Ligusticum,maidong_hemsl_light bamboo leaves_schisandrae_ginseng,codonopsis_licorice_red peony_gypsum,cohosh_aconite_staghorn gum_asarum,astragali_bitter orange_Rhizoma_Angelica_Sichuan_earthworm,pinellia_green skin_Polygala_calorin stone.Conclusions:1 Age,previous stroke history,TOAST classification,systolic blood pressure,PLT,D-dimer,FIB,ALB,ApoA1,NIHSS score before treatment and BI score before treatment were related to the early prognosis outcome of traditional Chinese medicine intervention,among which,PLT,NIHSS score before treatment,ApoA1 and TOAST classification may be independent factors affecting the short-term prognosis of patients with acute ischemic stroke.The performance of each quality assurance in predicting poor short-term prognosis was satisfactory.2 In the clinical treatment of AIS,the most commonly used traditional Chinese medicine is tonic-deficiency medicine,followed by blood-activating and blood-stasis drugs and heat-clearing drugs,etc.The main commonly used drugs are red peony root,Chuan xiong,Angelica sinensis,Pinellia pinellia,licorice root,peach kernel,safflower,Poria,Dilong,Astragalus,etc.In the treatment,we should treat all the samples together,pay attention to tonifying deficiency and strengthening health to treat the root cause,use the methods of clearing heat,promoting blood circulation,dissipating phlegm and soothing wind to remove pathogens to treat the symptoms,and use the treatment methods of clearing the bowels and relieving heat,nourishyin and promoting body fluid,treating internal and external wind together,and clearing phlegm and opening the orifices.