This study used electronic medical record (EMR) data to explore the risk factors for recurrence in patients with the first attack of cerebral infarction (CI). It expected to provide a scientific basis for improving the prognosis and reducing the recurrence rate of patients with CI. In this study, a retrospective search was performed for patients with the first attack of CI from 2017 to 2019 in the inpatient EMR system of a Traditional Chinese Medicine (TCM) hospital in Shandong. Patients were divided into 2 groups according to the recurrence of CI. The Mann-Whitney U Test and the chi-square test were used for statistical analysis. And the binary Logistic regression model and the Cox proportional hazards model were used to explore the risk factors affecting the recurrence of patients with CI and the factors affecting the recurrence days of patients with CI, respectively. Finally, 4597 patients with the first attack of CI were included, including 618 patients (13.44%) in the "recurrent CI group" and 3979 patients (86.56%) in the "non-recurrent CI group". Binary Logistic regression analysis showed that LOS (OR=1.035), type 2 diabetes mellitus (T2D) (OR=2.695), CMD (OR=3.272) and PLT (OR=2.628) were risk factors for recurrence in patients with CI. The results of Cox proportional hazards model analysis showed that the LOS at the first onset (HR=1.009) were the promoting factors affecting the recurrence days of patients with CI, and the CMD (HR=0.509) was the hindering factor affecting the recurrence days of patients with CI. This study proved the treatment of patients with CI with TCM decoction after discharge can delay the recurrence of CI. At the same time, attention should be paid to the treatment of patients with combined diseases, and the patients should be discharged after their condition being stable. When the patient was discharged from the hospital, a complete discharge doctor's order should be formulated to prevent recurrence, including medication for comorbid diseases, anti-platelet therapy, etc. In turn, it can improve the prognosis, reduce the recurrence, readmission rates, and reduce the disease burden of patients with CI.
WANG Shihua
,
ZHANG Li
,
WU Xiaowen
,
WEN Tiancai
,
AI Yanke
,
SUN Yuanyuan
,
LIU Jia
,
HE Liyun
. A real-world study on the risk factors of recurrence and the protective effect of Traditional Chinese Medicine in patients with cerebral infarction[J]. Science & Technology Review, 2023
, 41(14)
: 92
-100
.
DOI: 10.3981/j.issn.1000-7857.2023.14.011
[1] Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: Results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017, 135(8): 759-771.
[2] 王伟英, 桑文文, 焉双梅, 等 . 急性缺血性脑卒中患者1年复发危险因素Cox回归分析[J]. 中华老年心脑血管病杂志, 2016, 18(1): 46-50.
[3] Wang Y J, Li Z X, Gu H Q, et al. China Stroke Statistics 2019: A report from the national center for healthcare quality management in neurological diseases, China national clinical research center for neurological diseases, the Chinese stroke association, national center for chronic and non-communicable disease control and prevention, Chinese center for disease control and prevention and institute for global neuroscience and stroke collaborations[J]. Stroke and Vascular Neurology, 2020, 5(3): 211-239.
[4] Zhu D, Shi X, Nicholas S, et al. Medical service utilization and direct medical cost of stroke in urban China[J]. International Journal of Health Policy and Management, 2022, 11(3): 277-286.
[5] 赵俐红, 杨蓉, 涂双燕, 等. 脑卒中患者再入院及相关危险因素的研究现状[J]. 华西医学, 2015, 30(10): 1971-1974.
[6] Fehnel C R, Lee Y, Wendell L C, et al. Post-acute care data for predicting readmission after ischemic stroke: A nationwide cohort analysis using the minimum data set[J]. Journal of the American Heart Association, 2015, 4(9): e002145.
[7] Jencks S F, Williams M V, Coleman E A. Rehospitalizations among patients in the medicare fee-for-service program[J]. The New England Journal of Medicine, 2009, 360(14): 1418-1428.
[8] 谢雁鸣, 宇文亚, 王永炎 . 缺血性中风的二级预防及中医药应用述评[J]. 时珍国医国药, 2008(11): 2730-2731.
[9] 魏戌, 谢雁鸣, 王永炎 . 缺血性中风复发的临床研究概况及中医药防治策略[J]. 北京中医药大学学报, 2012, 35(12): 805-808.
[10] 吕富荣, 纪永毅, 刘岗, 等 . 中风病复中患者体质分布特点与危险因素的相关性研究[J]. 四川中医, 2017, 35(11): 62-65.
[11] 魏戌, 谢雁鸣, 常艳鹏, 等. 中医药干预缺血性中风病3年随访结局评价[J]. 中华中医药杂志, 2016, 31(10): 3970-3976.
[12] 中国脑血管病一级预防指南2019[J]. 中华神经科杂志, 2019(9): 684-709.
[13] 王拥军, 王春雪, 缪中荣. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南 2014[J]. 中华神经科杂志, 2015, 48(4): 258-273.
[14] Feigin V L, Stark B A, Johnson C O, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the global burden of disease study 2019[J]. The Lancet Neurology, 2021, 20(10): 795-820.
[15] 文天才, 刘保延, 张艳宁. 缺血性脑卒中患者31天内非计划性再入院风险因素研究: 随机森林模型[J]. 中国循证医学杂志, 2019(5): 532-538.
[16] 施霁桉, 赵丽 . 对病床周转率的反思[J]. 中外医学研究, 2015, 13(22): 148-150.
[17] Jia Q, Zheng H, Zhao X, et al. Abnormal glucose regulation in patients with acute stroke across China: Prevalence and baseline patient characteristics[J]. Stroke, 2012, 43(3): 650-657.
[18] 马成虹, 张危, 赵睿, 等. 2型糖尿病合并脑梗死的发病机制研究进展[J]. 现代医药卫生, 2020, 36(22): 3571-3574.
[19] 雷亚玲. 国内20年中医药治疗脑梗死的文献计量分析[J]. 世界中西医结合杂志, 2016, 11(1): 107-110.
[20] 高长玉, 吴成翰, 赵建国, 等 . 中国脑梗死中西医结合诊治指南(2017)[J]. 中国中西医结合杂志, 2018, 38(2): 136-144.
[21] 胡彦君, 钟良才, 李柏群 . 医院中药制剂发展模式、合理用药及研究方向探讨[J]. 药物评价研究, 2019, 42(5): 1020-1026.
[22] 中国急性缺血性脑卒中治疗现状[J]. 中华神经科杂志, 2009(4): 223-228.
[23] Wu B, Liu M, Liu H, et al. Meta-analysis of traditional Chinese patent medicine for ischemic stroke[J]. Stroke, 2007, 38(6): 1973-1979.
[24] Wang N L, Liou Y L, Lin M T, et al. Chinese herbal medicine, Shengmai San, is effective for improving circulatory shock and oxidative damage in the brain during heatstroke[J]. Journal of Pharmacological Sciences, 2005, 97(2): 253-265.
[25] Wang N L, Chang C K, Liou Y L, et al. Shengmai San, a Chinese herbal medicine protects against rat heat stroke by reducing inflammatory cytokines and nitric oxide formation[J]. Journal of Pharmacological Sciences, 2005, 98(1): 1-7.
[26] 韩冠先, 杨柳, 程鹏举, 等 . 三七愈风胶囊对缺血性中风二级预防临床研究 [J]. 光 明 中 医 , 2021, 36(24):4118-4122.
[27] 丁毅, 邢峰丽 . 中医治疗急性脑梗死的研究进展[J]. 中国中医急症, 2021, 30(6): 1121-1124, 1128.
[28] 李杰, 周芳名, 刘世平. 血常规相关指标与急性脑梗死相关性的研究进展[J]. 华西医学, 2022, 37(11): 1715-1719.
