| Objective:Collected through the cases of general information and its clinical data analysis,in cerebral infarction patients with diabetes mellitus based on clinical information distribution,discusses its correlation with the severity of the limb dysfunction,as well as the comprehensive acupuncture therapy to improve cerebral infarction of diabetes mellitus patients with limb dysfunction related factors.Methods:1 The subjects were patients with cerebral infarction complicated with diabetes who were admitted to the Acupuncture Department,Department of Encephalopathy Rehabilitation,and Department of Comprehensive Rehabilitation of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 1,2019 to December 31,2019.To explore the basic information distribution characteristics of patients with cerebral infarction complicated with diabetes by analyzing the general data of risk factors and the improvement of laboratory indicators and symptoms.2 From gender,age,disease course,Hb A1 c,the correlation between the severity of limb dysfunction and the above factors was analyzed;Starting from gender,age,course of disease,course of treatment,hemoglobin A1 c and dyslipidemia,the correlation between the improvement degree of limb dysfunction and the improvement degree of nerve function defect by acupuncture combined therapy and the above factors was analyzed.Results :1 General information: A total of 875 patients with cerebral infarction complicated with diabetes were included in this study,ranging from 26 years old to 92 years old,with a median age of 64 years old.There were more males than females,and the median age of male was lower than that of female.Most patients have muscle strength of grade 3 or above.Some cases were infected(121 cases),most of which were pulmonary infection(71 cases).Sleep disturbance(262 cases)was found in 29.9% of the patients,and gastrointestinal dysfunction(87 cases)and gastrointestinal bleeding(81 cases)were relatively low.The most widely distributed syndromes of TCM were Yin deficiency and wind movement syndrome(54.5%,477 cases),followed by wind and phlegm obstruction syndrome(20%,175 cases)Qi deficiency and blood stasis syndrome(18.6%,163 cases)Liver-yang hyperactivity syndrome(6.3%,55 cases)and phlegm heat and fu-organs syndrome(0.6%,5 cases).2 Risk factors: About 49.7% of the patients had a history of smoking(435 cases),and39.5% had a history of drinking(346 cases).The preexisting hypertension was the most common(77.8%,681 cases),followed by coronary heart disease(36.9%,323 cases),atrial fibrillation(4.5%,39 cases)and myocardial infarction(4.1%,36 cases).About 58.9% of the patients had no relevant family history.Among the patients with family history,family history of hypertension(192 cases)accounted for the largest proportion,followed by family history of diabetes(155 cases),family history of cerebrovascular disease(139 cases)and family history of coronary heart disease(26 cases).3 Laboratory indicators: Hb A1 c 7%(630 cases)in more than 70% patients,and Hb A1 c 8%accounted for more than 40%(374 cases).About 80.9% had dyslipidemia(708 cases);About11.8% had abnormal liver function(103 cases).About 29.1% of patients had abnormal renal function(255 cases).About 2.9% had low platelet count(25 cases),and about 5.5% had high platelet count(48 cases).The total abnormal platelet count rate was about 8.4%.About 39.7%(347 cases)had elevated D-dimer.About 32.3% had fibrinogen abnormalities(283cases);About 5.5%(48 cases)had abnormal APTT.Elevated blood homocysteine was found in10.1% of patients(88 cases).4 Treatment: Most of the included patients had upper and lower limb muscle strength of grade 3 or above,and about 29.5% were effectively improved.The course and course of treatment of most patients are within 28 days.The longest hospital stay was 90 days,with 75 days for males and 90 days for females.Drug use: During treatment,about 91.3% of the patients used lipid-regulating drugs(799 cases),about 62.1% used antihypertensive drugs(543 cases),about 86.2% used oral hypoglycemic drugs(754 cases),and 32.1% used insulin(281 cases).In terms of antiplatelet drugs,the utilization rate of aspirin was slightly higher than clopidogrel: 54.1% of aspirin(473 cases),49.1% of clopidogrel(430 cases),and 15.5%of aspirin combined with clopidogrel(136 cases).The rate of mecobalamine folate was less than 10%.In terms of symptom improvement,about 67.3%(589 cases)had language impairment,and the improvement rate was 27.5%.About 35.1% had dysphagia(307 cases),and the improvement rate was 36.2%.About 38.7% had sensory impairment(339 cases),and the improvement rate was 56.9%.5 Severity of upper limb dysfunction:Within 7 days of the onset of cerebral infarction,the degree of upper limb dysfunction was mild.Diabetic patients with Hb A1 c controlled at6.5-7% have a lower degree of upper limb dysfunction during cerebral infarction.No correlation was found between gender,age and the degree of upper limb dysfunction.6 Severity of lower limb dysfunction: Within 7 days of the onset of cerebral infarction,the degree of lower limb dysfunction was mild,but the degree of lower limb dysfunction is more serious 8-14 days after onset.The risk of more severe lower limb dysfunction increases with age.Women are more likely than men to show a higher degree of lower limb dysfunction when a diabetic has a cerebral infarction.No correlation was found between Hb A1 c and the degree of lower limb dysfunction.7 Upper limb muscle strength improvement: Within 14 days of the onset of cerebral infarction,Diabetic patients receiving acupuncture combined therapy are more likely to obtain ideal curative effect.Patients younger than 65 years old receiving acupuncture combined therapy are more likely to obtain ideal curative effect.In patients with DM who controlled Hb A1 c < 7%,Patients receiving acupuncture combined therapy within 7 days of the onset of cerebral infarction are more likely to obtain ideal curative effect;In patients with DM who controlled Hb A1 c from 7% to 8%,patients who Within 14 days of the onset of cerebral infarction or younger than 65 receiving acupuncture combined therapy are more likely to obtain ideal curative effect.8 Lower limb muscle strength improvement: Within 7 days of the onset of cerebral infarction,Diabetic patients receiving acupuncture combined therapy are more likely to obtain ideal curative effect.Women or patients younger than 65 years of age are more likely to obtain ideal curative effect.In patients with DM who controlled Hb A1 c from 7% to 8%,female patients are more likely to obtain ideal curative effect in lower limb muscle strength improvement.9 No influence of gender,age,course of disease,Hb A1 c,dyslipidemia on the improvement of neurological function deficit was found.Conclusion:1 The median age of patients with cerebral infarction complicated with diabetes admitted to our hospital in 2019 was 64 years old,most of them were male,and the longest hospital stay was 90 days,Most of the patients’ muscle strength was grade 3 or above,and about 29.5% of them were effectively improved.More than 70% patients had Hb A1c≥7%,and 42.7% had Hb A1c≥8%.2 The degree of dysfunction of upper and lower extremities in patients within 7 days of onset was relatively mild.The degree of dysfunction of upper extremities in patients with diabetes whose Hb A1 c was controlled at 6.5%-7% was relatively mild when cerebral infarction occurred.8 to 14 days after onset,older patients and women were more likely to present with more severe lower limb dysfunction.3 Patients under 65 years old or with early interventional acupuncture combined therapy are more likely to get the ideal effect of improving the muscle strength of upper and lower limbs.Female patients are more likely to obtain the ideal effect of lower limb muscle strength improvement.Among DM patients with Hb A1 c < 7%,the ideal effect of upper limb muscle strength improvement was more likely to be obtained within 7 days after the onset of cerebral infarction.Among DM patients with control 7%≤Hb A1 c < 8%,those with cerebral infarction onset less than 14 days or under 65 years of age were more likely to obtain the ideal efficacy of upper limb muscle strength improvement,and female patients were more likely to obtain the ideal efficacy of lower limb muscle strength improvement. |
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