The Study Of Nicotine Addiction Abstinence In Patients With Insular Infarction

Objective The insular lobe is one of the five cerebral lobes,which is located in a deeper position and has been rarely studied in the past.With the deepening of its research,some scholars have found that insular may be related to addiction.In this study,a series of scales were used to evaluate the withdrawal symptoms,smoking craving and withdrawal rate of patients with insular infarction,and to explore the effect of insular infarction on nicotine addiction.Methods From September 2016 to December 2017,149 patients with the first acute cerebral infarction were admitted to the First Affiliated Hospital of Anhui Medical University,the Third Affiliated Hospital of Anhui Medical University(Hefei First People's Hospital)and the Neurological Ward of Binhu Hospital.They were confirmed by cranial CT or magnetic resonance imaging.Among them,35 patients with insular infarction,There were 13 cases of left insular infarction,22 cases of right insular infarction and 114 cases of non-insular infarction.Inclusion criteria for insular infarction group:(1)All patients met the criteria of "Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China 2014" formulated by the Neurological Society of the Chinese Medical Association;(2)Before infarction,all subjects were regular smokers,that is,they met the definition of WHO Basic Principles on Smoking Behavior Survey(smoking at least one cigarette a day with a total of no less than 100 cigarettes in the past);(3)Smoking Dependence Scale(FTND)Scores(> 4 points);(4)they can understand and understand the contents of the scale;(5)be willing to cooperate with follow-up after 3 months;(6)Simple Mental Assessment Scale(MMSE)(> 24 points),with normal visual,auditory and linguistic comprehension and expression ability.The non-insular infarction patients matched with the demographic data of the insular infarction group were selected as the control group(n=114).During hospitalization,all subjects were assessed with the smoking craving scale(QSU)and the tobacco dependence assessment scale(FTND).The follow-up time window was 3 months.The patients who did not smoke and did not relapse were assessed with the QSU and MNWS scales.The patients who still smoked completed the QSU and FTND scales.For those who quit smoking during hospitalization and smoked again after discharge,the time from discharge to smoking again was recorded as relapse time.Results 1.After 3 months follow-up,the rate of withdrawal from insular damage was 77.14%,and that in non-insular damage was 52.63%(X2=6.62,P= 0.01),the difference was statistically significant? 2.The MNWS scores of patients with insular infarction who quit smoking and did not relapse after 3 months were(0.59±0.97)and(1.15±1.29)respectively.The difference was statistically significant(t=-2.00,P=0.04).3.All subjects were assessed with the smoking craving scale(QSU),The QSU score of patients with insular infarction was(19.40±9.63)and that of patients without insular infarction was(24.47 ±10.39).The difference was statistically significant(t=-2.57,P= 0.01).4.Comparison of days of relapse after withdrawal between the two groups after 3 months: Statistical analysis was made on those who quit smoking but again smoked during the period from discharge to follow-up.The number of relapsed smokers was 4 in insular infarction group,28 in non-insular infarction group and(31.00 ±12.27)in insular infarction group.The days of relapse in insular infarction group were significantly longer than those in non-insular infarction group(16.93 ±12.95),but there was no significant difference between the two groups(t=2.04,P = 0.77).5.Comparison of the withdrawal rates of left and right insular lobes: After 3 months,there were 27 patients with insular infarction,10 patients with left insular lobe infarction and 17 patients with right insular lobe infarction.The withdrawal rates were 77.27%.However,there was no significant difference between the two groups(x2 = 0.001,P = 0.98).Conclusion Patients with insular lesion are more likely to cause withdrawal of nicotine addiction,suggesting that insular may be involved in cognitive processing of addiction.