Abstract
Abstract: Objective: To investigate the management of perioperative target blood pressure in the treatment of acute ischemic stroke with intravenous thrombolytic bridging. Methods: Retrospective analysis of the blood pressure management and nursing experience of 36 patients with acute ischemic stroke who received endovascular treatment with bridge mode from November 2017 to January 2019 in our hospital. Through correct monitoring of basic blood pressure, rapid and stable blood pressure reduction before the bridge treatment, close cooperation during the operation, and close observation and treatment of postoperative blood pressure fluctuations, the patient’s blood pressure can be controlled within the target range. Results: The blood vessels of 36 patients were partially or completely recanalized after treatment. Clinical outcomes: Two cases died. After 90 days, 29 patients with good clinical outcomes were followed up, and 5 patients with poor clinical prognosis. Conclusion: Effective blood pressure management is a necessary measure in the perioperative period of bridging therapy for patients with acute ischemic stroke, which can reduce the postoperative complications of patients treated with bridging therapy, obtain good therapeutic effect and improve the prognosis of patients.
References
Zhou M,Wang H,Zhu J,et al. Cause-specific mortality for 240 causes in China during 1999-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013[J]. Lancet, 2016, 387(10015): 251-272. DOI:10.1016/SO140-6736(15)00551-6.
Wardlaw JM, Murray V,Berge E,et al.Recombinant tissue plasminogen activator for acute ischaemic stoke: an updated systematic review and meta-analysis[J]. Lancet, 2012, 379(9834): 2364-2372. DOI:10.1016/SO140-6736(12)60738-7.
Alexandrov AV. Current and future recanalization strategies for acute ischemic stroke[J]. J Intern Med, 2010, 267(2): 209-219.
Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Eng J Med. 2015. 372(11): 1009-1018.
Goyal M,Demchuk AM,Menon BK,et al. Randomized assessment of rapid Endovascular treatment of ischemic stroke[J]. N Engi J Med. 2015, 372(11):1019-1030.
Chinese Society of Neurology, neurovascular Interventional cooperation group of Chinese Society of Neurology, etc. Guidelines for early endovascular interventional therapy for acute ischemic stroke in China[J]. Chinese Journal of Neurology, 2015, 48(4): 356-361.
Chinese Society of Neurology, cerebrovascular disease section of Chinese Society of Neurology, neurovascular interventional cooperation group of Chinese Society of neurology, etc. Guidelines for early endovascular interventional therapy for acute ischemic stroke in China[J]. Chinese Journal of Neurology, 2018, 51(9): 683-691.
Tikhonoffv V, Zhang H,Richart T,et,al. Blood pressure as a prognostic factor after acute stroke[J]. Lancet Neurol, 2009, 8(10): 938-948. DOI:10.1016/S1474-4422(09)70184-X.
Jauch EC,Saver JL,Adams HP,et,al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2013, 44(3): 870-947. DOI:10.1161/STR.ObO13e318284056a.
He Yi. Effect of blood pressure fluctuation on prognosis of acute ischemic stroke treated with intravenous thrombolytic bridging[J]. Neural Injury and Functional Reconstruction, 2018, 13(5): 255-262.
Expert writing group of severe cerebrovascular disease branch of Chinese Stroke Association. Chinese expert consensus on monitoring and management of acute ischemic stroke after endovascular therapy[J]. Chinese Medical Journal, 2017, 97(3): 162-172.
Powers WJ,Rabinstein AA,Ackerson T,et,al.2018 guidelines for the early management of patient with acute ischemic stroke. Stroke, 2018, 49: e46-e110.
Nitin G,Georgios T,Abhi P,et al.Blood pressure levels post mechanical thrombectomy and outcomes in large vessel occlusion strokes. Neurology, 2017, 89: 1-8.