| Ischemic stroke is one of the common clinical chronic diseases hazarded to human health and lives, with four major characteristics of high incidence, high morbidity, high mortality and high recurrence rate. It is the disease as the main reason of disability and death in the elderly and one of the three diseases with the world's highest mortality rate. The one hand, the proposal of syndrome-elements better addresses the syndrome standardization, and this study discusses the laws of syndrome-elements and their combinations of ischemic stroke, using syndrome-elements theory—a new syndrome differentiation and treatment system.The other hand, with the development of medicine and the change in medical model, the patient reported outcomes (PRO) is more and more introduced into the study of Chinese medicine, and the doctor reported outcomes (DRO) has been proposed correspondingly. According to this, this research analyzes the correlation of syndrome-elements and nerve dysfunction and quality of life, and develops ideas for the in-depth research of the syndrome diagnosis and efficacy evaluation of ischemic stroke.Part ?ObjectThis research aimed at exploring the laws of syndrome-elements and their combinations of patients of ischemic stroke and laying the foundation for the research of the correlation of syndrome-elements and nerve dysfunction and quality of life.MethodsThrough a cross-sectional survey, the TCM symptoms and syndrome-elements of253cases of ischemic stroke patients were analyzed. And the descriptive analysis was the main method for data processing to investigate ischemic stroke syndromes-element characteristics and the rule of their combinations.ResultsThe syndrome-element with the highest frequency was blood stasis (75.89%), and others were phlegm-damp (69.96%), internal wind (57.71%), qi deficiency (24.11%), internal fire (13.04%), bowel excess (7.51%) and yin deficiency (5.93%). Excess syndromes were most, accounting for69.96%, excess and deficiency syndromes accounted for30.04%, and deficiency syndrome did not exist. Internal wind and phlegm-damp, internal wind and blood stasis, blood stasis and phlegm-damp, qi deficiency and blood stasis, internal fire and phlegm-damp, internal fire and bowel excess, internal wind and yin deficiency were closely related. The major syndrome-element combination is internal wind+phlegm-damp+blood stasis.ConclusionSyndrome-element of ischemic stroke had certain limitations, and there were some correlations between various syndrome-elements. According to some certain method combining syndrome-elements into syndromes was feasible.Part ?ObjectThis research aimed at evaluating the neurological deficit of patients with ischemic stroke and analyzing its relationship with syndrome-elements.MethodsUsing U.S. National Institutes of Health Stroke Scale (NIHSS), neurological deficits of253cases of ischemic stroke patients were evaluating. All data were presented by x±s and processed with SPSS20.0using the descriptive statistical analysis. Data fitted the normal distribution were analyzed by t-test and ANOVA, and data not fitted the normal distribution were analyzed by non-parametric test. Spearman rank correlation and multiple linear stepwise regression were used in the multivariate analysis.ResultsIn NIHSS score of253cases of ischemic stroke patients, admission score was6.81±3.11and score after7days was4.56±3.55. Patients with the decrease of NIHSS score accounted for83.40%, when the same accounted for11.07%and the rise accounted for5.53%. Admission score of internal fire group was significantly higher than that of qi deficiency group and blood stasis group, and its score after7days was significantly higher than that of qi deficiency group, blood stasis group and internal wind group (P<0.01or P<0.05). In the acute phase of ischemic stroke, admission score and score after7days of qi deficiency group were significantly lower than internal fire group and phlegm-damp group (P<0.01or P<0.05). Two factors internal fire and phlegm-damp and two scores admission score and score after7days were positively correlated, and there was a negative correlation between blood stasis, qi deficiency, coronary heart disease and the two scores. NIHSS score of excess syndrome patients was significantly higher than excess and deficiency syndrome (P <0.01). Though the statistics of combinations of syndrome-elements, compared with other groups, NIHSS scores of qi deficiency and blood stasis group, yin deficiency and internal wind group and internal wind, phlegm-damp and blood stasis group were significantly reduced. At the time of admission, factors as blood stasis, yin deficiency, coronary heart disease and bowel excess were negatively correlated with NIHSS scores. And after7days the influencing factors of NIHSS score were blood stasis and yin deficiency.ConclusionThere was a correlation between neurological deficits and syndrome-elements in ischemic stroke. The more obvious internal fire and phlegm-damp were meant the more serious neurological deficit was. And the more obvious blood stasis, qi deficiency and coronary heart disease were meant the lighter neurological deficit was. This will certainly be helpful for the treatment of ischemic stroke in Chinese medicine to promote the recovery of neurological function.Part ?ObjectThis research aimed at evaluating the quality of life patients with ischemic stroke and analyzing its relationship with syndrome-elements.MethodsUsing Stroke Specific Scale Quality of Life (SS-QOL), quality of life of253cases of ischemic stroke patients was evaluating. All data were presented by x±s and processed with SPSS20.0using the descriptive statistical analysis. Data fitted the normal distribution were analyzed by t-test and ANOVA, and data not fitted the normal distribution were analyzed by non-parametric test. Spearman rank correlation and multiple linear stepwise regression were used in the multivariate analysis.ResultsFrom the clinical data of this study, the overall quality of life scores in253cases of ischemic stroke patients were poor with a mean64.59±18.00. Internal fire group is poorer than others except of bowel excess group at the energy aspect (P<0.01or P<0.05). Bowel excess group is poorer than others except of internal fire group and phlegm-damp group at the energy aspect (P<0.05). The score of personality in yin deficiency group is higher than internal fire group and phlegm-damp group (P<0.05), and that in qi deficiency group is higher than phlegm-damp group (P<0.05). The score of thinking in yin deficiency group is higher than bowel excess group and internal fire group (P<0.05). The score of12items and the total score in qi deficiency group is higher than internal fire group (P<0.05). The score of language, activities of ability, personality, self-care ability, thinking and12items and the total score in excess and deficiency syndrome were all higher than excess syndrome (P<0.01or P<0.05). From the aspect of combinations of syndrome-elements, the score of energy in qi deficiency and blood stasis group is higher than phlegm-damp, internal fire and bowel excess group and other combinations group (P<0.05), and that in yin deficiency and internal wind group is higher than phlegm-damp, internal fire and bowel excess group (P<0.05). The personality score in qi deficiency and blood stasis group is higher than other combination group, and that in yin deficiency and internal wind group is higher than internal wind, phlegm-damp and blood stasis group and other combinations group. The thinking score in yin deficiency and internal wind group is higher than phlegm-damp, internal fire and bowel excess group and other combinations group (P<0.05).Through the rank correlation analysis of each influence factor and the score of quality of life, each one of11factors as age, gender, internal fire, phlegm-damp, blood stasis, qi deficiency, yin deficiency, bowel excess, diabetes, coronary heart disease and the score of neurological deficit had a correlation (positive and negative) with one or several items of SS-QOL. Internal fire is the influence factor of energy, family role, emotion, social role and upper limb function, and phlegm-damp is the factor of language, personality and thinking.ConclusionThere were correlations between syndrome-elements and patients'quality of life. Different syndrome-elements had different characteristics of the correlation with quality of life. In order to enhance the overall patients'quality of life, this study provided some help for the efficacy evaluation and the prognosis of patients with different syndromes. |
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