Research On The Related Factors Of Stroke Recurrence Based On The Theory Of Disease Prevention

Object(1)Through the follow-up of patients with ischemic stroke,the clinical features of recurrent and non-recurrent cases were compared,and the influencing factors related to stroke recurrence were explored to provide theoretical support for secondary prevention of stroke.(2)Through the investigation of the changes of the disease before the onset of stroke recurrence,summarize the clinical characterization of the early warning of stroke recurrence,and provide early warning signals for the recurrence of stroke.MethodsClinical study oneThe study included a follow-up study of patients enrolled in stroke and a nested case-control study.Clinical information collection for patients with stroke registration(including general information,admission diagnosis,vital signs,past history,family history,morbidity,complications,life behavior,exercise,mental state,drug use related to stroke,TCM constitution,relevant scales,laboratory test indicators,imaging examinations and other dimensions).Field survey and telephone follow-up for 12 months,recording end events(including recurrence events,death outcomes and allelopathy events)).Comparing the clinical factors of relapsed and non-relapsed patients to study the relapsed-related factors by the nested case-control studyThe clinical data was recorded into the Epidata software independently by the double double recording method,and the "differential check" was performed on the two entered data.Descriptive statistical analysis was performed on the characteristics of the two groups of patients by SPSS 22.0 statistical software.The count data were expressed as frequency and percentage,and the measurement data were expressed as mean ± standard deviation(x ±s).The comparison of the count data was performed by chi-square test,and the comparison of measurement data was performed by t test;the non-normal distribution data was compared by non-parametric rank sum test.Clinical study twoA cross-sectional study was conducted to retrospectively investigate the clinical manifestations of pre-morbid changes in patients with recurrent stroke,and to collect general data,onset(first,recurrence,predisposing factors,etc.)and past medical history(hypertension,diabetes,high fat).Clinical information such as blood,coronary heart disease,atrial fibrillation,personal history(body type,personality,work nature,tobacco and alcohol hobbies,dietary taste,exercise),family history of cardiovascular and cerebrovascular diseases.The clinical data is applied to the two-person independent entry using the EXCEL form,and the third person checks the information and establishes a database.The general characteristics of patients with recurrent stroke were described using SPSS 22.0 statistical software.The count data were expressed as frequency and percentage,and the measurement data were expressed as mean±standard deviation(x ±s).Correlation studies between recurrence and clinical presentation of the initial group were performed using a cross-linked chi-square test.ResultsClinical study one(1)A total of 340 patients were enrolled,and one of them was excluded because the age did not meet the inclusion criteria.332 cases were followed up by telephone,274 cases were followed up for the second time,and 7 cases were lost to follow-up.58 patients were excluded from the second on-site follow-up information,so 274 patients were included in the study.During the follow-up period of one year,there were 28 cases of recurrent ischemic stroke,and the recurrence rate was 10.2%.The recurrence rates in January,February,March,June,and December after the onset were 1.5%,0.7%,1.8%,2.6%,and 3.7%,respectively.The cumulative recurrence rate was 4.0%in the 3 months after stroke and 6.6%in the 6 months after stroke.There were 5 cases of cardiovascular allelic events,accounting for 1.8%;5 cases of death,accounting for 1.8%.Among them,1 case had recurrence and combined allelic events,and 1 case had an allelic event combined with death outcome.(2)Patients with recurrent episodes of recurrence during follow-up were enrolled in the study group.Using the Nest's case-control study,patients with no endpoints during the follow-up period were selected as the control group by age-stratified factors.Using recurrence as a grouping factor,a univariate analysis was performed between the two groups.The severity of stroke(first stroke,National Institutes of Health Stroke Scale,Daily Living Ability Rating Scale,mRS Scale,taking Chinese medicine),history of diabetes,family history of stroke-related risk factors(family history of hypertension,family history of diabetes,family history of multiple risk factors aggregation),metabolic dysfunction(central obesity,uric acid level),psychological factors(depression self-rating scale),vascular conditions(intracranial stenosis,carotid plaque),abnormal blood components(anemia,coagulation abnormalities),etc.There were differences in the aspects,and the difference was statistically significant,P<0.05.Clinical study two(1)There are 63.2%of stroke patients with clear incentives before recurrence.The proportion of recurrence incentives from high to low is:fatigue,anger or anger,weather changes,nervousness,unhealthy diet,forced bowel movements,and excessive exertion.(2)The clinical characterization of the pre-recurrence of stroke showed the characteristics of syndromes of "wind-fire","phlegm”,"qi deficiency" and "blood stasis",suggesting that the pathogenesis of high-risk clinical characterization before stroke recurrence is consistent with the pathogenesis of stroke,"wind" and "fire" "phlegm" "stagnation"and "weak",coexist and affect each other.(3)Taking the first occurrence and recurrence as the dependent variable,the clinical manifestation of the pre-onset stroke was used as the independent variable,and the chi-square test was performed.The recurrent stroke patients showed apathy,unresponsiveness,frequent headaches,blurred vision or blurred vision,chest tightness and chest pain.The frequency of reflexes,constipation,and a few days,a sudden walking to one side,the proportion of transient ataxia was higher than that of the first group.The cross-linked chi-square test showed statistically significant difference,P<0.05.(4)The clinical characterization of the changes in the condition before the onset of stroke has the characteristics of dynamic evolution at any time.In the 7 days before the onset of recurrent stroke,the "wind-fire" syndrome is the main symptom.8-30 days before the onset of the disease,the syndromes of“fire-heat" "qi deficiency" and "blood stasis" are the main symptoms,and 31-60 days before the onset of illness " phlegm " qi deficiency" and"fire-heat" syndromes;In the 7 days before the onset of the first stroke,the syndromes of"wind" and "qi deficiency" were mainly used.The syndromes of "qi deficiency" and"phlegm-fire" were mainly 8-30 days before the onset of the disease,and 31-60 days before the onset of illness,"phlegm" "phlegm-fire" and "blood stasis" syndromes are dominant.ConclusionClinical study onePatients with first-episode stroke have severe neurological deficits.Patients with central obesity,uric acid metabolism disorder,diabetes,anemia,intracranial vascular stenosis and other family members with high blood pressure and family history of diabetes have a higher risk of re-stroke.Stroke patients should actively identify the controllable risk factors and correct them in time,which has an important impact on improving the prognosis of patients and reducing the recurrence rate.Clinical study two(1)The recurrence of stroke is a multi-risk factor aggregation,plus the results induced by external factors,patients with stroke should pay attention to avoid the cause of the disease,which is conducive to reducing the risk of recurrence.(2)The syndrome elements of pre-onset recurrent stroke have a dynamic evolution process,showing different syndrome characteristics from the first stroke.(3)The "fire-heat" syndrome plays a leading role in the recurrence of stroke disease.The"high-risk state" indicating the recurrence of stroke in the "wind-fire" syndrome should cause clinical attention."qi deficiency" is an important syndrome factor reflecting the changes of the disease before stroke.