Characteristics,Prognosis And Prognostic Factors For Dysphagia Patients Post Cerebral Ischemia Receiving Acupuncture Combined Therapy

Objective:1.To explore the basic situation of the general population of patients with dysphagia caused by cerebral infarction from the aspects of basic conditions,treatment,symptom improvement,adverse complications and health economics;2.To investigate the prognosis and influencing factors of swallowing function,lung infection,urinary tract infection,length of hospital stay in patients with dysphagia after cerebral infarction;3.To explore the influence of the time point of acupuncture intervention on the prognosis of patients with dysphagia after cerebral infarctionMethods:This study is a retrospective study based on inpatient electronic medical record data1.based on the first affiliated hospital of Tianjin medical university intelligent data management platform,collecting on January 1,2018 to December 31,2018,during the visits of the medical records of hospitalized patients with swallowing disorder after cerebral infarction,basic situation from the crowd,interventions,symptom improvement and adverse complications,hospitalization burden of exploring our overall distribution characteristics of swallowing disorder after cerebral infarction.By comparing the differences of adverse complications and length of hospital stay between SAP and non-SAP patients,the influence of secondary SAP on the prognosis of patients with dysphagia after cerebral infarction was discussed2.A retrospective cohort study was designed to divide 1026 patients with post infarction dysphagia into early acupuncture group(227 cases)and non-early acupuncture group(799 cases)Results:1.A total of 1026 patients were included,with an average age of 66.19 years old.Most of the patients had a history of smoking,and nearly half of the patients had a history of drinking alcohol.In the previous history,hypertension accounted for the largest proportion,followed by hyperlipidemia,cerebrovascular disease,diabetes,coronary heart disease,atrial fibrillation,and 23.3%had a family history of cerebrovascular disease.The proportion of medium stroke patients was the highest,followed by mild stroke,and the proportion of severe stroke patients was only 8.0%,mainly in the non-acute stage,and there were fewer patients with medulla oblongata injury,consciousness disorder and mental disorder.The distribution of TCM syndromes was successively from high to low:Yin deficiency syndrome,qi deficiency and blood stasis syndrome,wind-phlegm-obstructing collaterals syndrome,Liver-Yang Bao-kang syndrome,and phlegm-heat viscera demonstration.About 1/4 of the patients received thrombolytic therapy,of which 45.3%were inhospital thrombolysis and 54.7%were out hospital thrombolysis.About 1/4 of the patients needed nasal feeding,and more than 2/3 were taken out of the hospital.More than one-third of patients require electrocardiogram monitoring during hospitalization.During the treatment period,the swallowing function improvement rate was 78.7%,the limb muscle strength improvement rate was 32.7%,and the NIHSS score improvement rate was 43.5%.In terms of complications,the incidence of SAP was 23.3%,urinary tract infection 7.4%,hypoproteinemia 11.2%,anemia 20.9%,and electrolyte disturbance 77.6%.In terms of health economics,the length of hospitalization was the longest 86 days and the shortest 7 days,with an average of 18.23 days.The average hospitalization cost is 23,000 yuan2.The influential factors for the recovery of swallowing function in patients with cerebral infarction dysphagia may include previous coronary heart disease,family history of stroke,and nasal feeding.The effect of acupuncture intervention point on the improvement of swallowing function has not been confirmed3.Men,severe stroke,previous atrial fibrillation,combined with mental disorder,consciousness disorder,urinary tract infection,and received nasal feeding,ecg monitoring patients with cerebral infarction dysphagia were more likely to have pulmonary infection.Women,moderate stroke,patients with pulmonary infection,and those requiring electrocardiogram monitoring may be more likely to have urinary tract infections.Early acupuncture may prevent urinary tract infection,but the correlation between early acupuncture and lung infection has not been confirmed4.Patients with severe stroke,previous hyperlipidemia,ecg monitoring,combined with pulmonary infection,anemia,electrolyte disturbance may have a higher risk of prolonged hospital stay,and early acupuncture may have a shorter hospital stayConclusion:1.Most of the patients with dyspnea after cerebral infarction were admitted to our hospital in the non-acute stage,and most of them had mild or medium stroke.Most of them were not accompanied by medulla oblongata injury,consciousness disorder or mental disorder,and their conditions were relatively stable.Most of the patients are elderly and male,and most of them have recurrent stroke.Most of the patients have bad living habits such as smoking and drinking,and the proportion of previous hypertension,hyperlipidemia and diabetes is high.Therefore,the occurrence of cardiovascular diseases should be kept on alert.Dysphagia may increase the length of hospital stay and medical expenses of patients with cerebral infarction;2.No correlation was found between the time point of acupuncture intervention and the improvement of swallowing function;3.Early acupuncture intervention can reduce the incidence of nosocomial urinary tract infection in patients with dysphagia caused by cerebral infarction,which may be related to the reduction of the incidence of pulmonary infection.4.Early acupuncture intervention can shorten the length of stay in hospital for patients with dysphagia.