| ObjectiveBy comparing the differences between the initial qi-deficiency syndrome and the non-qi-deficiency syndrome of ischemic stroke in general situation,four diagnostic information,laboratory examination and neurological deficit,this paper analyzes and summarizes the clinical characteristics of the initial qi-deficiency syndrome of ischemic stroke,so as to provide support for early clinical identification of the initial qi-deficiency syndrome and improve the accuracy of syndrome differentiation.By observing the evolution trend of different syndromes at different time points in the acute stage of ischemic stroke and analyzing the relationship between them and prognosis,this paper explores the evolution trend of initial Qi deficiency syndrome and the relationship between the evolution of non-Qi deficiency syndrome and Qi deficiency.In order to further explore the significance of Qi deficiency in the evolution of syndromes in the initial stage and acute stage of stroke,grasp the development trend of the disease,cut off the disease in time and improve the curative effect of clinical treatment based on syndrome differentiation.Method1.Cross-sectional study was used to explore the clinical characteristics of the initial Qi deficiency syndrome of ischemic stroke.Patients were divided into ① Qi deficiency syndrome group:experts judged that Qi deficiency syndrome was established and the main syndrome;② Non-Qi deficiency syndrome group:Experts judged that Qi deficiency syndrome was not established.Syndromes are judged by at least two experts at deputy senior level or above in the sub-center according to the diagnostic criteria.If there is any inconsistency,it will be judged by the senior experts with the longest experience in the team.The study group with Qi deficiency syndrome in the initial state of apoplexy and the control group with non-Qi deficiency syndrome were used to collect relevant clinical data,and the general data,four diagnosis information,laboratory examination results and neurological deficit degree of the two groups were compared,so as to analyze and summarize the clinical characteristics of Qi deficiency syndrome in the initial state of ischemic apoplexy.2.Using dynamic observation method to explore the evolution trend of initial syndrome of ischemic stroke.At baseline,at the 72nd hour,at the 7th day and at the 14th day of onset,the syndrome types of patients in each group were judged by experts at the deputy senior level or above in the sub-center.Patients were divided into five groups according to baseline syndromes:① Qi deficiency syndrome group;② Qi deficiency group;③ Wind phlegm and blood stasis blocking vein group;④ Wind-fire disturbance group;⑤ Wind-phlegm disturbance group.In order to facilitate observation and summary,the evolution syndromes are summarized into the following six types:① Qi deficiency syndrome is the main syndrome(hereinafter referred to as Qi deficiency syndrome);② both Qi deficiency;③Phlegm and blood stasis blocking collaterals;④ yin deficiency and yang hyperactivity;⑤Phlegm-heat connotation;⑥ Others.Summarize the distribution of syndromes and the transfer rate between syndromes in each group at different time points,summarize the evolution trend of different baseline syndromes,and analyze the relationship between different evolution characteristics and prognosis,so as to explore the evolution trend of initial Qi deficiency syndrome in acute stage of stroke and the relationship between the evolution of non-Qi deficiency syndrome and Qi deficiency.Results1.Clinical characteristics of Qi deficiency syndrome in the initial state of ischemic stroke(1)Compared with non-Qi-deficiency syndrome group,the proportion of women in Qi-deficiency syndrome group is more(P<0.05),and the proportion of patients with continuous drinking and smoking history is even less(P<0.05).There was no significant difference in age,inducement,onset season and solar terms between the two groups(P>0.05).(2)There was no significant difference in the past basic diseases(hypertension,diabetes and coronary heart disease)between the two groups(P>0.05).(3)Compared with the non-Qi-deficiency syndrome group,the Qi-deficiency syndrome group has four diagnostic characteristics,such as "listlessness,lack of qi,laziness in speaking,shortness of breath,sallow complexion,blurred vision,pale tongue,fat body and white tongue coating"(P<0.05).(4)Compared with non-Qi-deficiency syndrome group,the contents of hemoglobin,direct bilirubin,high-density lipoprotein cholesterol,monocyte/high-density lipoprotein cholesterol and homocysteine in Qi-deficiency syndrome group are all lower(P<0.05).2 Study on the Evolution of Initial Syndrome of Ischemic Stroke(1)the evolution trend of the initial Qi deficiency syndrome,both Qi deficiency syndrome and the relationship between the evolution of non-Qi deficiency syndrome and Qi deficiency.① About 75%of the patients in the Qi-deficiency syndrome group were still Qi-deficiency syndrome within the 14th day of onset,and 20%of them turned into Qi-deficiency with phlegm-heat accumulation or phlegm-blood stasis blocking collaterals;70%of the patients who turned into Qi deficiency with phlegm-heat connotation within 72 hours after onset did not continue to evolve,while 20%continued to evolve into phlegm and blood stasis blocking collaterals or reverting to Qi deficiency syndrome.② About 60%of patients in the group with Qi deficiency persist in the syndrome of Qi deficiency,and 30%of patients turn into Qi deficiency syndrome or phlegm-heat accumulation within 14 days of onset.③ About 92%of the patients in the group with wind,phlegm and blood stasis blocking collaterals changed to phlegm and blood stasis blocking collaterals within 72 hours after onset.About 36%of patients changed to phlegm-heat within 72 hours after onset,and the evolution direction was mainly from the disappearance of heat image to the obstruction of collaterals by phlegm and blood stasis,followed by Qi deficiency syndrome.④ In the wind-fire disturbance group,about 72%of the patients’ heat symptoms persisted within the 14th day of onset,24%turned to phlegm and blood stasis blocking collaterals within the 14th day of onset,and 3%turned to Qi deficiency syndrome.⑤ About 72%of patients in the wind-phlegm disturbance group had obvious heat image,of which 65%persisted within the 14th day of onset,and 32%turned to phlegm and blood stasis blocking collaterals after the heat image subsided;About 26%of patients have no obvious heat image,of which 90%are always phlegm and blood stasis blocking collaterals,and 10%are phlegm and blood stasis blocking collaterals with Qi deficiency.(2)The evolution trend,characteristics and prognosis of initial syndrome.① At baseline,the number of people with syndrome of wind phlegm and blood stasis blocking veins was the largest,accounting for the largest proportion(28.7%).The syndrome of phlegm and blood stasis blocking collaterals is stable and difficult to continue to evolve,accounting for the largest proportion(34.1%)on the 14th day of onset.Changing into phlegm-heat is more likely to evolve,and the evolution direction is mainly due to both Qi deficiency and phlegm and blood stasis blocking collaterals.② From the initial state to the 14th day of stroke,the proportion of patients with Qi deficiency syndrome and both Qi deficiency syndrome is increasing.73%of the patients turned into Qi deficiency syndrome occurred from the 7th to 14th day of onset.③ Compared with patients whose baseline syndrome is wind-phlegm and blood stasis blocking veins,patients whose baseline syndrome is wind-phlegm disturbance are more likely to have poor prognosis(P<0.05).Compared with patients who developed phlegm and blood stasis blocking collaterals,patients who developed phlegm and heat were more likely to have poor prognosis(P<0.05).Conclusions1.Female patients are more likely to show Qi deficiency syndrome in the initial state when they have a stroke.Patients with a history of continuous drinking and smoking are more likely to show Non-Qi deficiency syndrome in the initial state.2."Mental fatigue","lack of qi and laziness in speaking","sallow complexion","shortness of breath","pale tongue","fat tongue","white fur" and "blurred vision" can reflect the four diagnostic characteristics of Qi deficiency syndrome in the initial state of ischemic stroke to some extent.3.Hemoglobin content,direct bilirubin,high-density lipoprotein cholesterol,monocyte high-density lipoprotein cholesterol ratio,homocysteine may be related to the formation of initial Qi deficiency syndrome.The level of protective factors and oxidative stress in patients with initial Qi deficiency syndrome of ischemic stroke were lower than those without Qi deficiency syndrome.4.Wind phlegm and blood stasis blocking veins account for the largest proportion of the initial syndromes of stroke;On the 14th day of onset,phlegm and blood stasis were the most common syndromes.Most of the patients with obvious initial heat image of stroke persist within 14 days after onset.5.Most of the patients with Qi deficiency syndrome or Qi deficiency in the initial stage of stroke are still Qi deficiency and blood stasis syndrome or Qi deficiency in the acute stage.6.In the acute phase,the number of patients with various syndromes changing to Qi deficiency syndrome or both Qi deficiency syndrome is increasing,and most of them appear in the period from the seventh day to the fourteenth day of onset.7.As far as the initial syndrome is concerned,wind-phlegm disturbance is more likely to cause poor prognosis than wind-phlegm and blood stasis blocking the vein;As far as the evolution of syndrome is concerned,it is more likely to have a bad prognosis if it evolves into phlegm-heat connotation than phlegm-blood stasis blocking collaterals. |
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