■为了确定与常规治疗相比,机械血栓切除术联合长期亚低温治疗急性大脑中动脉闭塞的疗效,并探讨延长低温持续时间是否能改善神经功能。
■2018年至2023年6月,对苏州九龙医院NICU收治的45例急性大脑中动脉闭塞患者进行回顾性分析,附属于上海交通大学医学院。血栓切除术后,患者被送入神经内科重症监护病房(NICU)进行有针对性的体温管理.患者分为两组:亚低温组(34.5-35.9°C)接受5-7天的治疗,和正常体温组(对照组),其体温使用药物和物理降温方法保持在36至37.5°C之间。比较两组患者的基线特征和体温变化。主要结果是手术后3个月的改良Rankin量表(mRS)评分,次要结局是相关并发症和死亡率。使用单变量和多变量逻辑回归分析来调查预后危险因素。
■在45名患者中,21人接受了长时间的亚低温治疗,24人接受了正常体温,两组之间的基线特征没有显着差异。轻度低温的持续时间为5至7天。寒战的发生率(33.3%vs.8.3%,p=0.031)和便秘(57.1%vs.20.8%,p=0.028)在亚低温组明显高于对照组。亚低温组和对照组的死亡率无显著差异(4.76%vs.8.33%,p=1.000,OR=1.75,95%CI,0.171-17.949)。3个月时,亚低温组和对照组之间的改良mRS(0-3)评分没有显着差异(52.4%vs.25%,p=0.114,OR=0.477,95%CI,0.214-1.066)。梗死核心体积是神经系统不良结局的独立危险因素。
■机械取栓术后长期亚低温无严重并发症,有改善神经功能预后的趋势。CTP梗死核心体积是预测神经功能的独立危险因素。
UNASSIGNED: To determine the efficacy of mechanical thrombectomy combined with prolonged mild hypothermia compared with conventional treatment in managing acute middle cerebral artery occlusion, and to explore whether extending the duration of hypothermia can improve neurological function.
UNASSIGNED: From 2018 to June 2023, a retrospective analysis was conducted on 45 patients with acute middle cerebral artery occlusion treated at the NICU of Suzhou Kowloon Hospital, affiliated with Shanghai Jiao Tong University School of Medicine. After thrombectomy, patients were admitted to the neurological intensive care unit (NICU) for targeted temperature management. Patients were divided into two groups: the mild hypothermia group (34.5-35.9°C) receiving 5-7 days of treatment, and the normothermia group (control group) whose body temperature was kept between 36 and 37.5°C using pharmacological and physical cooling methods. Baseline characteristics and temperature changes were compared between the two groups of patients. The primary outcome was the modified Rankin Scale (mRS) score at 3 month after surgery, and the secondary outcomes were related complications and mortality rate. Prognostic risk factors were investigated using both univariate and multivariate logistic regression analyses.
UNASSIGNED: Among 45 patients, 21 underwent prolonged mild hypothermia, and 24 received normothermia, with no significant differences in baseline characteristics between the two groups. The duration of mild hypothermia ranged from 5 to 7 days. The incidence of chills (33.3% vs. 8.3%, p = 0.031) and constipation (57.1% vs. 20.8%, p = 0.028) was significantly higher in the mild hypothermia group compared with the control group. There was no significant difference in mortality rates between the mild hypothermia and the control group (4.76% vs. 8.33%, p = 1.000, OR = 1.75, 95% CI, 0.171-17.949). At 3 month, there was no significant difference in the modified mRS (0-3) score between the mild hypothermia and control groups (52.4% vs. 25%, p = 0.114, OR = 0.477, 95% CI, 0.214-1.066). Infarct core volume was an independent risk factor for adverse neurological outcomes.
UNASSIGNED: Prolonged mild hypothermia following mechanical thrombectomy had no severe complications and shows a trend to improve the prognosis of neurological function. The Infarct core volume on CTP was an independent risk factor for predicting neurological function.