Résumé
Objective To observe the severity of cerebral edema after mechanical thrombectomy in the patients with acute ischemic stroke caused by large vessel occlusion,and to statistically analyze the related fac-tors affecting the prognosis quality of the patients,so as to guide the patients to conduct scientific interven-tion.Methods Ninety-one patients with acute ischemic stroke due to anterior circulation large vessel occlusion treated with mechanical thrombectomy in this hospital from October 2021 to October 2022 served as the ana-lytic subjects.According to the severity of brain edema,they were divided into the group Ⅰ(mild),group Ⅱ(moderate),and group Ⅲ(severe);after 12-week treatment,the improved Rankin scale was used to evaluate the prognosis.The patients with good prognosis were included in the excellent group,and the patients with poor prognosis were included in the poor group.Single factor and multifactor logistic analysis was used to ana-lyze the influencing factors and prognostic related factors of different degrees of brain edema.Results The univariate analysis showed that the percentage of patients with NIHSS score at admission ≥15,time from on-set to thrombolysis ≥6 h,history of hypertension,successful vascular recanalization and good collateral circu-lation were significantly different among the groups Ⅰ,Ⅱ and Ⅲ(P＜0.05);the multivariate logistic regres-sion analysis results showed that the NIHSS score at admission ≥15,time from onset to thrombolysis ≥6 h,and hypertension history were the risk factors leading to severe cerebral edema,while successful recanalization of blood vessels was a protective factor for cerebral edema(P＜0.05).The univariate analysis showed that in the good prognosis group the percentage of patients had good circulation of lateral branches,successful reca-nalization of blood vessels,severe cerebral edema,hypertension,time from onset to thrombolysis ≥6 h,and NIHSS score ≥15 at admission were significantly different from those in the poor prognosis group(P＜0.05).The multivariate logistic regression analysis results showed that severe cerebral edema,time from onset to thrombolysis ≥6 h and NIHSS score ≥15 at admission were the risk factors for poor prognosis,while good collateral circulation and successful recanalization of blood vessels were the positive factors for good prognosis(P＜0.05).Conclusion Mechanical thrombectomy patients with hypertension and time from onset to throm-bolysis ≥6 h and NIHSS score at admission ≥15 have more severe brain edema after treatment;severe brain edema,time from onset to thrombolysis ≥6 h,NIHSS score at admission ≥15 were the adverse factors affect-ing the prognosis of the patients with mechanical thrombectomy.
Résumé
Liver diseases are associated with complex abnormalities in the coagulation system as the liver is involved in the synthesis of various coagulation-related proteins. Laboratory and clinical evidence suggests that patients with liver disease may achieve a state of rebalanced hemostasis, but such balance is relatively unstable, and thus bleeding and thrombosis events are observed in clinical practice. Patients with acute or chronic liver diseases might be admitted to the intensive care unit (ICU) due to serious complications such as bleeding and thrombosis. Gastrointestinal bleeding, systemic or local thrombosis, and coagulation events in extracorporeal circulation are common complications observed in patients with liver disease in the ICU. An individualized management plan of thromboprophylaxis and a wait-and-see policy for limited blood transfusion are reasonable for patients with liver disease.
Résumé
Objective To investigate the relationship between electrolyte level change with prognosis in the patients with craniocerebral injury.Methods A total of 360 patients with craniocerebral injury in this hospital during 2012-2015 were selected as the research subjects and divided into the mild craniocerebral injury group (171 cases),moderate craniocerebral injury group(104 cases)and severe craniocerebral injury group(85 cases) according to the Glasgow coma scale.The severe craniocerebral injury group was further divided into the high level blood sodium subgroup(73 cases)and stable level blood sodium subgroup(12 cases)according to the lev-el of blood sodium,meanwhile 70 persons undergoing healthy physical examination were selected as the control group.The plasma electrolyte levels(blood sodium,potassium,chloride)in each group were detected within 5 d after admission.Then the results were statistically analyzed.Results Compared with the control group,the blood sodium,potassium and chloride levels had no statistical difference between the mild and moderate craniocerebral injury groups(P>0.05).The blood sodium and chloride levels in the severe craniocerebral inju-ry group were higher than those in the mild and moderate craniocerebral injury groups,the difference was sta-tistically significant(P<0.01).The blood potassium level had no statistical difference between the mild,mod-erate and severe craniocerebral injury groups with control group(P>0.05).In the severe craniocerebral injury group,there were 58 cases(79.45%)of death in the high level blood sodium subgroup and 4 cases(33.33%) of death in the stable level blood sodium subgroup,the difference was statistically significant(P<0.01).Con-clusion Clinically monitoring the blood sodium level change in the patients with craniocerebral injury,espe-cially severe craniocerebral injury,is conducive to the disease recovery.