Analysis Of Onset Time And Prognosis Related Factors In Patients With Aneurysmal Subarachnoid Hemorrhage

Objective 1.To explore the relationship between the onset time of aneurysmal subarachnoid hemorrhage(aSAH)and the time variation of meridian flow in traditional Chinese medicine,and to provide some ideas for the prevention and treatment of aSAH;2.Statistical analysis was performed on factors associated with prognosis in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods 1.A retrospective study was conducted to collect relevant data of 470 patients with aSAH who met the inclusion criteria in the Zhejiang Provincial Hospital of Traditional Chinese Medicine,Zhejiang Tongde Hospital,Zhejiang People's Hospital,and the First Affiliated Hospital of Zhejiang University School of Medicine.1.Method of collecting time of onset:(1)The specific onset date and corresponding solar terms of patients were collected and divided into four seasons according to the nodes of early spring,early summer,early autumn and early winter.;(2)The time of onset of the aneurysmal subarachnoid hemorrhage patient within 24 hours and the corresponding one of the 12 two-hour periods of the day.2 Research methods of prognostic factors2.1 Methods for collecting prognostic factors :It mainly includes patients,aneurysms,functional status at onset,etc.(1)Patient: age,gender,personal history(smoking,drinking),past history(hypertension).(2)Aneurysm:location,size,treatment.(3)Assessment of neurological status at admission: Hunt-Hess scale,Glasgow Coma Scale(GCS),WFNS(World Federation of Neurological Surgeons,WFNS)scale.2.2 Prognostic evaluation index : Glasgow Prognosis Score was used to assess the neurological status of patients discharged from hospital,including those who died due to ineffective treatment,GOS < 3 was defined as poor prognosis.2.3 Statistical methods: SPSS19.0 statistical software package was used for data analysis.The measurement data were expressed as mean ± standard deviation(x ± s),obeyed by normal distribution using t test,and did not conform to normal distribution using ranksum test;The ?2 test was used.Sex,hypertension,Hunt-hess and WFNS were treated by two-class variables,three-class variables were used for treatment,four-class variables were used for size of aneurysms,and six-class variables were used for location of aneurysms.Logistic regression analysis was used for univariate analysis and multivariate analysis.with P<0.05 as statistically significant.Results 1.(1)Among the 24 solar terms,the two most common solar terms are the spring equinox and the winter solstice.The incidence of winter and spring fluctuates greatly,with obvious peaks,while in summer and autumn,the incidence is relatively stable and not big different.(2)The first three most common time of onset at 12 o'clock are Mao Shi,Youshi and Shenshi in turn.The corresponding meridians are Hand Yangming Large Intestine Meridian,Foot Shaoyin Kidney Meridian and Foot Sun Bladder Meridian.2.(1)univariate analysis of the collected factors,the results showed age(P=0.002),history of hypertension(?2=4.826,P=0.028),Hunt-hess rating(?2=61.872,P<0.001),Hunt The difference between the-Hess rating(?2=61.872,P<0.001)and the treatment(?2=12.320,P=0.002)was statistically significant.Therefore there were significant differences in the prognosis of aSAH in age,history of hypertension,Hunt-hess rating,Hunt-Hess rating and treatment methods.Sex,location and size of aneurysms have little effect on prognosis.(2)Multivariate analysis of factors with statistically significant differences in univariate analysis showed that age,WFNS score,DSA embolization,and craniotomy were independent risk factors for aSAH.Conclusion 1.The onset of aneurysm is related to the change of climate in four seasons,the movement of Qi and blood in one day and the rise and fall of yin and yang,and is also affected by defecation,mood fluctuation,fatigue and sleepiness.Therefore,according to the meridian flow theory,aneurysms patients' daily life can follow the basic work and rest rules,avoid wind and cold,avoid fatigue,emotional stimulation,constipation and so on.2.Patients of intracranial aneurysms with hypertension are more likely to develop subarachnoid hemorrhage.Hypertensive patients are more susceptible to the disease.Neurological function is positively correlated with prognosis.Surgical treatment is an effective way to improve the cure rate.Once the patients are diagnosed,they should remove the contraindications of surgery and perform surgery.Patients with unruptured aneurysms(UIA)should regulate their blood pressure,conduct outpatient follow-up and,if necessary,surgicalintervention;patients with ruptured aneurysms(RIA)should select appropriate surgical treatment according to the comprehensive assessment to achieve better prognosis.