脑氧饱和度监测目标导向治疗在急性缺血性脑卒中机械取栓术后管理中的效果

The Effect of Cerebral Oxygen Saturation Monitoring Goal-directed Therapy in the Management of Acute Ischemic Stroke after Mechanical Thrombectomy

目的观察急性缺血性脑卒中机械取栓术后管理中应用脑氧饱和度监测目标导向治疗的临床效果。方法选取2020年4月—2022年10月新疆医科大学第一附属医院昌吉分院神经医学科收治的急性缺血性脑卒中机械取栓术患者60例,根据随机对照法分为两组,各30例,对照组进行常规神经重症监护治疗,包括降血压治疗、抗凝治疗,基础疾病积极治疗等,研究组在对照组的基础上予以局部脑氧饱和度(rScO2)目标导向治疗,分析两组取栓术前、取栓术后24 h、1个月、3个月、1年的脑氧监测数值、mRS评分、NIHSS评分,及病死率、脑血管再闭塞、脑出血转化发生率。结果两组取栓术后24 h、1个月、3个月、1年后的rScO2值均高于治疗前,且研究组高于对照组,而mRS评分、NIHSS评分均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组的病死率、脑血管再闭塞、脑出血转化总发生率20.0%低于对照组的46.7%,差异有统计学意义(χ^(2)=4.80,P<0.05)。结论急性缺血性脑卒中机械取栓术后管理中应用脑氧饱和度监测目标导向治疗,可明显改善脑神经功能缺损状态,降低病死率及并发症发生率。

Objective To observe the clinical effect of cerebral oxygen saturation monitoring goal-directed therapy in the management of acute ischemic stroke after mechanical thrombectomy.Methods Sixty patients with acute ischemic stroke who underwent mechanical thrombectomy at the Department of Neuromedicine,Changji Branch of the First Affiliated Hospital of Xinjiang Medical University from April 2020 to October 2022 were selected and randomly divided into two groups,each with 30 cases.The control group received routine neurointensive care treatment,including blood pressure lowering therapy,anticoagulant therapy,and active treatment for underlying diseases.On the basis of the control group,the research group received targeted treatment with local cerebral oxygen saturation(rScO2),and analyzed the cerebral oxygen monitoring values,mRS scores,NIHSS scores,as well as the mortality rate,cerebrovascular re occlusion,and incidence of cerebral hemorrhage transformation before and 24 hours,1 month,3 months,and 1 year after thrombectomy in both groups.Results The rScO2 values 24 hours,1 month,3 months,and 1 year after thrombectomy in both groups were higher than before treatment,and the study group was higher than the control group.The mRS score and NIHSS score were lower than before treatment,and the study group was lower than the control group,the difference was statistically significant(P<0.05).The mortality rate,total incidence of cerebral vascular re occlusion and cerebral hemorrhage transformation in the study group were 20.0%,lower than 46.7%in the control group,the difference was statistically significant(χ^(2)=4.80,P<0.05).Conclusion The application of cerebral oxygen saturation monitoring and target oriented treatment in the postoperative management of mechanical thrombectomy for acute ischemic stroke can significantly improve the state of neurological deficits,reduce mortality and incidence of complications.