The Clinical Treatment Of Acute Ischemic Stroke

[Objective]To evaluate the treatment of acute ischemic stroke on outcomes in a hospital-based stroke registry.[Methods]A retrospective cohort study was conducted.First-ever ischemic stroke patients admitted to Kunming General Hospital of PLA from January 2014 to October 2017 were enrolled.The following information was included through a standardized data extraction table including:age,gender,stroke onset time,stroke severity at admission,risk factors(including hypertension,diabetes,coronary heart disease,smoking and drinking history,etc.),etiologic type,and classification of clinical symptoms,results of blood biochemical tests,medications during hospitalization(antiplatelet drugs,anti-hypotensives,statins,Traditional Chinese Medicines,neuroprotectives,hypoglycemic drugs,dehydrants),types,dosage and days of intravenous infusion,disability and survival at discharge and the end of follow-up,and survival time was calculated.Multiple linear regression and logistic regression analysis were used to performmulti-factor analysis.Outcome events were analyzed using cox regression,Kaplan-Meier survival curves was obtained.[Results]A total of 3127 cases were screened in this study.There were 739 first-ever ischemic stroke cases that met the inclusion criteria,including 154 cases in 2014,186 cases in 2015,207 cases in 2016,and 192 cases in 2017.Among the cases included,there were 479 men(64.82%)with a maximum age of 95 years,a minimum age of 18 years and an average age of 66.44±13.55 years.The neurological deficit scores in patients admitted to hospital:5.72±4.19,discharge:4.18±4.08.529 patients with hypertension,accounting for 71.58%;201 patients with diabetes,accounting for 27.20%;276 patients with hyperlipidemia,accounting for 37.35;161 patients with coronary atherosclerotic heart disease,accounting for 21.79%;216 patients with hyperuricemia,accounting for 29.23%;293 patients with hyperhomocysteinemia,accounting for 39.65%;172 patients with smoking,accounting for 23.27%;108 patients with drinking,accounting for 14.61%.The average length of hospitalization was 13.56±5.67 days;the average days of intravenous infusion was 13.39±5.69 days;the average intravenous infusion volume was 9614,19±7721.29ml;the median number of days for using mannitol injection was 5 days.In the OCSP,Partial anterior circulation infarcts accounted for the highest proportion of 80.7%;In the CISS,the intracranial and extracranial atherosclerotic stroke accounted for the highest proportion of 70.8%.In patients with acute ischemic stroke,87.69%of patients referred antiplatelet drugs;81.17%of patients received statins;81.85%of patients received anti-hypotensives;88.56%of patients received hypoglycemic drugs;99.05%of patients received neuroprotectives medication;98.24%of patients received Traditional Chinese Medicines.In the past four years,the use of antiplatelet drugs,statins,anti-hypotensives,and hypoglycemic drugs had shown a trend of growth.The use rate of Traditional Chinese Medicines and neuroprotectives drugs was the highest,and the average annual utilization rate was flat.Multiple linear regression analysis revealed the total amount of mannitol of intravenous infusion was significant positively correlated with the neurological deficit at discharge(B=0.00,P<0.001);the total amount of isotonic saline of intravenous infusion was significantpositively correlated with the neurological deficit at discharge(B=0.00,P<0.001).The use of antiplatelet drugs was negatively correlated with neurological deficit at discharge(B=-1.71,P<0.001);there was a negative correlation between the use of anti-hypotensives and neurological deficit at discharged(B=(-0.88,P<0.05).There was not statistical difference between other drugs and neurological deficit at discharge.Multivariate logistic regression analysis showed that the use of Traditional Chinese Medicines(OR=0.17,95%CI=0.04-0.72)and anti-hypotensives(OR=0.46,95%CI=0.26-0.82)reduce the risk of 90-day disability.After correcting for risk factors,there was no significant correlation between anti-hypotensives and Traditional Chinese Medicines and the risk of 90-day disability.The total of isotonic saline and mannitol were unsignificantpositively correlated with the risk of 90-day disability(OR = 1.00,95%CI = 1.00-1.00).Multivariate cox regression analysis determined that the use of statins reduced the risk of 90-day death(HR=0.46,95%CI=0.23-0.92).[Conclusion](1)Based on the single-center review,clinical treatment of acute ischemic stroke had become increasingly standard.The use of antiplatelet drugs,statins,anti-hypotensives,and hypoglycemic drugs had improved significantly over the past four years.The use of antiplatelet drugs,statins,and secondary preventive drugs were higher,and Traditional Chinese Medicines and neuroprotective medication were the most common.(2)Patients with first-ever acute ischemic stroke generally received the therapy of intravenous infusion.Within a reasonable range,the type and amount of vehicle were unsignificant correlated with the neurological deficit and 90-day prognosis.(3)The neurological deficit at discharge was significantly improved by using antiplatelet drugs and anti-hypotensives,and the use of statins reduced the risk of 90-daydeath(4)The absence of indications for mannitol did not significantly improve neurological deficits at dischargeand 90-day prognosis for acuteischemic stroke.