The Effect Of Regular Outpatient Follow-up On Recurrence Of Cerebral Infarction With Large-artery Atherosclerosis

Objective To know the risk factors timely and conduct the intervention through regular outpatient follow-up;To understand the compliance and rationality of patients with drug treatment and conduct education;To find out in time whether the patient has sleep disorder,anxiety state,depression state and other conditions and carry out intervention treatment;To analyze the effect of comprehensive management of regular outpatient follow-up on the recurrence of cerebral infarction with large-artery atherosclerosis in one year;To seek an effective way for secondary prevention.Methods This study is a prospective,randomized controlled trial.From October 2016 to December 2017,cerebral infarction patients with large-artery atherosclerosis(according to TOAST classification standard)admitted in the department of neurology in WuYuan County People's Hospital in Inner Mongolia were collected.Patients were followed up for 12 months(until December 2018).We collected 248 cases,included treatment group and control group(n = 124).The patients in treatment group were visited in 3 months,6 months and 12 months after discharged and patients in control group were only visited in 12 months after discharged.3-month and 6-month follow-up included the control of blood pressure,blood glucose and blood lipid and patients were given timely intervention to reach the standard.If not quit smoking,patients were given health education and family members would supervise smoking cessation.Knowing the use of secondary prophylactic drugs,patients were educated to ensure drug compliance.The PHQ-9 scale,GAD-7 scale and PSQI scale were used to screen the patients for depression state,anxiety state and sleep disorders.Patients with abnormal were given timely psychiatric consultation and supportive psychological treatment or drug intervention treatment.Patients were recorded for recurrence.Finally,at the 12-month follow-up,the two groups were mainly evaluated for statistical differences in recurrence rates.Secondly,the statistical differences in drug compliance,risk factor control,post-stroke sleepdisorder,anxiety state and depression state were evaluated.Results 3 cases lost follow-up in the control group and no cases lost in the study group.There were significant differences in the recurrence of stroke(18.2% and 4%)and smoking cessation(28.9% and 95.9%)between the control group and the study group(P < 0.001).Stroke recurrence in the study group was significantly lower than that in the control group.Smoking cessation rate in the study group was significantly higher than that in the control group.There were significant differences in the control group and the study group in the drug compliance of antiplatelet drugs,lipid-lowering drugs,antihypertensive drugs and hypoglycemic drugs(82.6%,53.7%,88.5%,88.6% vs.99.2%,92.7%,100%,100%).The study group was significantly better than the control group(P < 0.05).The blood lipid,blood pressure and blood glucose compliance rates(41.3%,70.5%,38.4% vs 84.7%,93.6%,85.7%)showed significant differences(P < 0.001),and the compliance rates of the study group were significantly higher than those of the control group.Patients with depression state,anxiety state,anxiety and depression state and sleep disorders who needs psychiatric intervention treatment in control group were more than in study group(43.8%,45.4%,33%,58.7%,62%vs 7.3%,3.2%,3.2%,6.5%,8.9%).There were obvious differences in two groups(P < 0.001).All biochemical indexes and score data in the control group and the research group were analyzed,and the differences were significant(P < 0.05),while those in the research group were lower than in the control group.There were no significant differences in stroke recurrence rate,smoking cessation rate,drug dependence,blood pressure compliance rate and blood glucose compliance rate in the study group in 3,6 and 12 months of follow-up(P >0.05).The differences of lipid compliance rates(72.6% vs 86.3% vs 84.7%)were significant(P < 0.05).The proportion of depression state,anxiety state,anxiety and depression state,sleep disorder and the need for psychiatric intervention accounted for 31.5%,50%,29%,63.7%,64.5% vs 14.5%,11%,7.3%,25.8%,26.6% vs 7.3%,3.2%,3.2%,6.5%,8.9%.Statistical chi-square test showed that test showed that there were significant differences among the three groups(P < 0.001).All biochemical indexes and scoring data were tested by statistical anova,and there was no statistical significance in the differences in high-density lipoprotein,fasting blood glucose,glycosylated hemoglobin and NIHSS scores(P > 0.05),while the differences in other indexes were significant(P < 0.05).The biochemical indexes in the 12-month follow-up were the lowest.The above statistical results suggested that regular outpatient follow-up significantly reduced the recurrence rate of cerebral infarction with large-artery atherosclerosis,improved the patient's compliance with secondary prevention drugs,increased the compliance rate of blood pressure,blood glucose and blood lipids and increased the smoking cessation rate.Additionally,the regular outpatient follow-up significantly improved the post-stroke anxiety state,depression state and sleep disorders.Conclusion Regular outpatient follow-up might effectively control the risk factors of patients of cerebral infarction with large-artery atherosclerosis,improve the compliance of patients with secondary prevention drugs and the state of post-stroke anxiety state,depression state and sleep disorders.Through this comprehensive management method could significantly reduce the recurrence of cerebral infarction with large-artery atherosclerosis.Analysis and comparison of various indicators at 3,6 and 12 months in the study group showed that there were statistically significant differences in TG,TC,LDL-C,PHQ-9,GAD-7,PSQI and mRS among the three groups(the lowest at 12-month),prompt with the extension of regular follow-up and standardized management time,the better management of blood lipid,anxiety state,depression state and sleep disorder,the more effective it may be to reduce the recurrence rate of patients,and may be positively correlated with the improvement of neurological function prognosis of patients,which needs to be confirmed by further increasing follow-up time,sample size and refinement grouping.