| ObjectiveThere is increasing evidence that sleep disorders have a continuing negative impact on quality of life after cardio-cerebral vascular disease.Stroke-related sleep disorders include insomnia,sleep apnea,drowsiness,restless leg syndrome,and many other forms.Post-stroke insomnia is one of the common complications after cerebrovascular disease,which not only seriously affects the rehabilitation of stroke survivors,It can also reduce patient survival and quality of life.Although modern doctors have accumulated rich and valuable clinical experience in the treatment of insomnia after stroke,there is no systematic summary of the etiology and pathogenesis,the relationship between physique,symptoms and insomnia after stroke,and the clinical symptoms of traditional Chinese medicine that are commonly seen.This topic is based on the basic and clinical research of sleep disorders after stroke by domestic and foreign scholars.It is a prospective clinical observational study of post-stroke insomnia during recovery and a cross-sectional clinical observational study of post-stroke insomnia.The method of analysis summarizes the treatment of insomnia after stroke with traditional Chinese and western medicine,in order to complete the preliminary exploration of the causes of insomnia after stroke,clarify its relationship with common cerebrovascular risk factors,TCM constitutional symptoms and systematically summarize the characteri-stics of TCM treatment of insomnia after stroke And experience,enrich the content of traditional Chinese medicine in the study of insomnia after stroke and use it as a starting point for the related research of TCM,and strive to provide methodological experience for future Chinese medicine research on post-stroke complications.MethodsThis topic is divided into four parts.The first part is a comprehensive review of the domestic and foreign research reports on stroke and various forms of sleep disorders.A literature review has been completed,and the research progress on the relationship between stroke and various sleep disorders has been initially summarized from both Chinese and Western medicine.In the second and third parts,prospective and cross-sectional clinical studies were used to collect clinical factors related to traditional Chinese and western medicine in patients with stroke during recovery period,and the incidence factors of insomnia after stroke were summarized through logistic regression analysis.Part Five,searching China Knowledge Base,Wanfang Data,Pubmed,Web of science and other databases to include randomized controlled trials of traditional Chinese and western medicine versus simple western medicine for post-stroke insomnia.Meta-analysis was performed on acupuncture,combined acupuncture,and simple The comparison of auricular points with pure western medicine in terms of efficiency,cure rate,PSQI score,summarizes the choice of traditional Chinese medicine and degree of contemporary doctors,and provides a basis for the promotion of the use of acupuncture and other therapies for post-stroke insomnia.Results1.Summarized by literature research,some scholars at home and abroad have explored the development of sleep disorders and stroke,and the emergence of sleep disorders after stroke,and found that various forms of post-stroke sleep disorders may have multiple pathological mechanisms between stroke and stroke.Linked up,can even form a vicious circle.2.There is no disease name and special treatment of post-stroke sleep disorders in the classics of traditional Chinese medicine,but as a theoretical source,it guides the treatment of post-stroke sleep disorders in China.At present,the traditional Chinese medicine treatment of sleep disorders after stroke,especially sleep apnea,drowsiness,and restless leg syndrome,is mainly based on case and clinical experience,and there is no systematic understanding of the etiology and pathogenesis of sleep disorders in various forms.Chinese medical doctors have made a lot of explorations on the treatment of insomnia after stroke,especially the combination of multiple treatments,which has a significant effect,and is worthy of further research and promotion.3.Prospectively collected clinically relevant factors of 275 patients with acute stroke,and explored the pathogenesis of insomnia after stroke during recovery.According to the results of Logistic regression analysis,in western medicine,glycated hemoglobin,young and old,insomnia,NIHSS score)10 points,antibiotic application,carotid sclerosis,anxiety,stroke,and depression are risk factors for insomnia 3 months after stroke.The OR values are 5.92,0.3,4.4,5.33,6.81,2.73,2.92,3.53,2.94.In terms of Chinese medicine,according to the results of Logistic regression analysis,the clinical symptom score of stroke is>40 points,do not want to eat,eat too much,have low mood,sentimental feelings,insomnia,dreams of blood stasis,skin nail defects,palpitations,phlegm,Damp heat quality,sputum,and abdominal fullness are common elements of insomnia 3 months after stroke,and their OR values are 4.29,4.3,5.15,2.6,4.56,17.04,9.99,2.86,3.09,5.55,11.7,13.36,3.5,7.83.4.Logistic regression was used to explore the insomnia after recovery stroke in patients with stroke syndrome and gender,age,clinical type,incidence site,number of incidence,season of onset,stroke location,and physique.It was found that the disease location was in the posterior circulation and the location was left Lateral,right,male,older than 75 years old,blood stasis and insomnia,wind and phlegm obstruction syndrome after stroke often appear at the same time.The onset season is in spring,when the constitution is yang deficiency,and the yin deficiency wind movement syndrome often occurs simultaneously with insomnia after stroke,while men do not appear at the same time as the yin deficiency wind movement syndrome.5.Collecting clinically relevant factors of patients with sequelae stroke through cross-sectional study,and exploring the pathogenesis of insomnia after sequelae stroke.According to the results of Logistic regression analysis,in western medicine,diabetes,brain stem,depression,heart disease,glycated hemoglobin,lesions>2,men,BMI>24kg/m2,and history of insomnia are all risk factors for insomnia after stroke.In TCM,according to the results of Logistic regression analysis,chest tightness,qi deficiency,insomnia,headache,headache,clinical symptoms score of stroke<20 points,depression,goodness,too much fatigue,fatigue,dizziness,wind and phlegm obstruction,shortness of breath Lazy speech and bad wind are common combined elements of insomnia during stroke sequelae.6.Logistic regression was used to explore insomnia after stroke in patients with sequelae in stroke syndrome and gender,age,clinical type,location of disease,number of onsets,season of onset,location of stroke,and physique.It was found that insomnia after stroke caused by wind-phlegm obstruction Patients younger than 44 years of age and older than 75 years of age are more common in the wind phlegm obstruction syndrome of insomnia after stroke during sequelae,while the hemorrhagic stroke is less common with wind phlegm obstruction syndrome in insomnia after stroke at sequelae.The onset season is in the spring,when the constitution is yang deficiency,peace is often accompanied by yin deficiency wind movement syndrome of insomnia after stroke,but hemorrhagic stroke does not occur at the same time with yin deficiency wind movement syndrome.7.The results of direct meta-analysis and reticular meta-analysis show that pure acupuncture,acupuncture combined with auricular acupuncture,compared with simple western medicine for post-stroke insomnia have a good effect on the effectiveness,recovery rate,and PSQI score,but adverse reactions There are fewer aspects.Conclusion1.Combining literature research and clinical observation research,whether in the recovery or sequelae period,blood glucose,history of insomnia,and depression are all related to the risk factors of insomnia after stroke.During the recovery period,the stroke-related acute phase has been treated with antibiotics and the NIHSS score>10 is the risk factor.2.In terms of traditional Chinese medicine,the results of logistic regression analysis of clinical studies suggest that,whether in the recovery period or the sequelae,goodness,too much interest,depression,and insomnia are common complications that are not easy to occur after stroke.The occurrence of insomnia is more susceptible to the effects of receptors such as blood stasis,phlegm and dampness,and damp heat.3.For stroke patients with wind and phlegm obstruction syndrome both in the recovery phase and sequelae,the age of more than 75 years is a common factor.Quality and stroke incidence are common factors in spring.4.Meta analysis shows that acupuncture therapy has a good clinical effect compared with western medicine alone,and it has more advantages in improving limb function and reducing adverse reactions,which deserves further promotion.However,given the low quality of randomized controlled trials and the existence of heterogeneity between studies,it is encouraged to further develop high-quality clinical research in the future to provide experimental basis for the international promotion of Chinese medicine for post-stroke insomnia. |
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