[1]沈刘艳,张静,邬幼萍.大核心梗死缺血性卒中血管内治疗术后护理进展[J].中国临床神经外科杂志,2024,29(07):437-441.[doi:10.13798/j.issn.1009-153X.2024.07.012]
　SHEN Liu-yan,ZHANG Jing,WU You-ping.Progress in postoperative nursing care for patients with acute ischemic stroke associated with large-core infarction undergoing endovascular therapy[J].,2024,29(07):437-441.[doi:10.13798/j.issn.1009-153X.2024.07.012]
点击复制

大核心梗死缺血性卒中血管内治疗术后护理进展()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年07期
页码:
437-441
栏目:
综述
出版日期:
2024-07-30

文章信息/Info

Title:
Progress in postoperative nursing care for patients with acute ischemic stroke associated with large-core infarction undergoing endovascular therapy
文章编号:
1009-153X（2024）07-0437-05
作者:
沈刘艳; 张静; 邬幼萍
214000江苏无锡，联勤保障部队第九〇四医院神经外科（沈刘艳、张静、邬幼萍）
Author(s):
SHEN Liu-yan;  ZHANG Jing;  WU You-ping
Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support force, Wuxi 214000, China
关键词:
急性缺血性脑卒中; 大核心梗死; 血管内治疗; 护理
Keywords:
Acute ischemic stroke;  Large core infarction;  Endovascular therapy;  Nursing care
分类号:
R 743
DOI:
10.13798/j.issn.1009-153X.2024.07.012
文献标志码:
A
摘要:
临床上，约1/4的大血管闭塞性急性缺血性脑卒中病人存在大的梗死核心。这类病人以减轻脑水肿、缓解颅内压升高、防止出血转化和其他继发性损伤为主要治疗原则。由于出血转化和再灌注损伤的风险较高，血管内治疗对伴有大核心梗死的急性缺血性脑卒中的作用尚存有争议。最近，有研究报道血管内治疗对伴大核心梗死的缺血性卒中病人的预后有益处，但是术后存在继发性脑损伤的风险，因此，需要细致的护理以改善其预后。良好的护理对优化血压控制、减轻继发性脑损伤、控制脑水肿和神经保护具有重要作用。本文就伴大核心梗死的缺血性卒中病人血管内治疗术后护理进展作一综述。
Abstract:
Clinically, approximately one-fourth of patients with large vessel occlusion acute ischemic stroke present with large infarct cores. The main treatment principles for these patients are to alleviate brain edema, relieve elevated intracranial pressure, prevent hemorrhagic transformation, and other secondary injuries. Due to the high risks of hemorrhagic transformation and reperfusion injury, the efficacy of endovascular therapy for patients with acute ischemic stroke associated with large core infarction remains controversial. Recently, studies have reported that endovascular therapy is beneficial for the prognosis of patients with ischemic stroke accompanied by large core infarction; however, there is a risk of secondary brain injury after the operation. Therefore, meticulous nursing is required to improve their prognosis. Excellent nursing plays a crucial role in optimizing blood pressure control, reducing secondary brain injury, controlling brain edema, and providing neuroprotection. This article presents a review on the progress of postoperative nursing for patients with ischemic stroke accompanied by large core infarction after endovascular therapy.

参考文献/References:

[1]HUO X, MA G, ZHANG X, et al. Endovascular therapy in acute anterior circulation large vessel occlusive patients with a large infarct core (ANGEL-ASPECT): protocol of a multicentre randomised trial [J]. Stroke Vasc Neurol, 2023, 8(2): 169-174.
[2]LIM GZ, LAI JY, SEET CYH, et al. Revolutionizing the management of large-core ischaemic strokes: decoding the success of endovascular therapy in the recent stroke trials[J]. J Cardiovasc Dev Dis, 2023, 10(12): 499-507.
[3]LESLIE-MAZWI TM, ALTSCHUL D, SIMONSEN CZ. Thrombectomy for patients with large infarct core in practice: where should the pendulum swing[J]. Stroke, 2021, 52(10): 3118-3120.
[4]POWERS WJ, RABINSTEIN AA, ACKERSON T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50(12): e344-e418.
[5]REININK H, JOTTLER E, HACKE W, et al. Surgical decompression for space-occupying hemispheric infarction: a systematic review and individual patient meta-analysis of randomized clinical trials[J]. JAMA Neurol, 2021, 78(2): 208-216.
[6]YOSHIMURA S, SAKAI N, YAMAGAMI H, et al. Endovascular therapy for acute stroke with a large ischemic region[J]. N Engl J Med, 2022, 386(14): 1303-1313.
[7]SARRAJ A, HASSAN AE, ABRAHAM MG, et al. Trial of endovascular thrombectomy for large ischemic strokes[J]. N Engl J Med, 2023, 388(14): 1259-1271.
[8]HUO X, MA G, TONG X, et al. Trial of endovascular therapy for acute ischemic stroke with large infarct[J]. N Engl J Med, 2023, 388 (14): 1272-1283.
[9]NANNONI S, RICCIARDI F, STRAMBO D, et al. Correlation between ASPECTS and core volume on CT perfusion: impact of time since stroke onset and presence of large-vessel occlusion[J]. Am J Neuroradiol, 2021, 42(3): 422-428.
[10]SARRAJ A, CAMPBELL B, RIBO M, et al. SELECTion criteria for large core trials: dogma or data[J]. J Neurointerv Surg, 2021, 13(6): 500-504.
[11]FAYAD P. Improved prospects for thrombectomy in large ischemic stroke[J]. N Engl J Med, 2023, 388(14): 1326-1328.
[12]ABDOLLAHIFARD S, TAHERIFARD E, SADEGHI A, et al. Endovascular therapy for acute stroke with a large infarct core: a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis, 2023, 32(12): 107427-107436.
[13]PALAIODIMOU L, SARRAJ A, SAFOURIS A, et al. Endovascular treatment for large-core ischaemic stroke: a meta-analysis of randomised controlled clinical trials[J]. J Neurol Neurosurg Psychiatry, 2023, 94(10): 781-785.
[14]NAIR-COLLINS M, JOFFE AR. Frequent preservation of neurologic function in brain death and brainstem death entails false-positive misdiagnosis and cerebral perfusion[J]. AJOB Neurosci, 2023, 14(3): 255-268.
[15]MATUSEVICIUS M, COORAY C, BOTTAI M, et al. Blood pressure after endovascular thrombectomy: modeling for outcomes based on recanalization status[J]. Stroke, 2020, 51(2): 519-525.
[16]SAMUELS N, VAN DE GRAAF RA, VAN DEN BERG CAL, et al. blood pressure in the first 6 hours following endovascular treatment for ischemic stroke is associated with outcome[J]. Stroke, 2021, 52 (11): 3514-3522.
[17]MORRIS NA, JINDAL G, CHATURVEDI S. Intensive blood pressure control after mechanical thrombectomy for acute ischemic stroke[J]. Stroke, 2023, 54(5): 1457-1461.
[18]MAZIGHI M, RICHARD S, LAPERGUE B, et al. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET): a multicentre, open-label, randomised controlled trial[J]. Lancet Neurol, 2021, 20 (4): 265-274.
[19]YANG P, SONG L, ZHANG Y, et al. Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial[J]. Lancet, 2022, 400(10363): 1585-1596.
[20]MISTRY EA, HART KW, DAVIS LT, et al. Blood pressure management after endovascular therapy for acute ischemic stroke: the best-ii randomized clinical trial[J]. JAMA, 2023, 330(9): 821-831.
[21]NAM HS, KIM YD, HEO J, et al. Intensive vs conventional blood pressure lowering after endovascular thrombectomy in acute ischemic stroke: the optimal-bp randomized clinical trial[J]. JAMA, 2023, 330(9): 832-842.
[22]MISTRY EA, MEHTA T, MISTRY A, et al. Blood pressure variability and neurologic outcome after endovascular thrombectomy: a secondary analysis of the BEST study[J]. Stroke, 2020, 51(2): 511-518.
[23]LIEBESKIND DS, JOTTLER E, SHAPOVALOV Y, et al. Cerebral edema associated with large hemispheric infarction[J]. Stroke, 2019, 50(9): 2619-2625.
[24]COOK AM, MORGAN JONES G, HAWRYLUK GWJ, et al. Guide-lines for the acute treatment of cerebral edema in neurocritical care patients[J]. Neurocrit Care, 2020, 32(3): 647-666.
[25]MOHNEY N, ALKHATIB O, KOCH S, et al. What is the role of hyperosmolar therapy in hemispheric stroke patients[J]. Neurocrit Care, 2020, 32(2): 609-619.
[26]LIN J, FRONTERA JA. Decompressive hemicraniectomy for large hemispheric strokes[J]. Stroke, 2021, 52(4): 1500-1510.
[27]KOO J, LEE J, LEE SH, et al. Does the size of unilateral decompressive craniectomy impact clinical outcomes in patients with intracranial mass effect after severe traumatic brain injury[J]. Korean J Neurotrauma, 2021, 17(1): 3-14.
[28]WU L, WU D, YANG T, et al. Hypothermic neuroprotection against acute ischemic stroke: the 2019 update[J]. J Cereb Blood Flow Metab, 2020, 40(3): 461-481.
[29]NEUGEBAUER H, SCHNEIDER H, BESEL J, et al. Outcomes of hypothermia in addition to decompressive hemicraniectomy in treatment of malignant middle cerebral artery stroke: a randomized clinical trial[J]. JAMA Neurol, 2019, 76(5): 571-579.
[30]JHA RM, RANI A, DESAI SM, et al. Sulfonylurea receptor 1 in central nervous system injury: an updated review[J]. Int J Mol Sci, 2021, 22(21): 11899-11959.
[31]KIMBERLY WT, BEVERS MB, VON KUMMER R, et al. Effect of IV glyburide on adjudicated edema endpoints in the GAMES-RP trial[J]. Neurology, 2018, 91(23): e2163-e2169.
[32]FERREIRA-ATUESTA C, DOHLER N, ERDOLYI-CANAVESE B, et al. Seizures after ischemic stroke: a matched multicenter study[J]. Ann Neurol, 2021, 90(5): 808-820.
[33]BAUTISTA C. Monitoring for poststroke seizures[J]. Crit Care Nurs Clin, 2020, 32(1): 85-95.
[34]JONES FJS, SANCHES PR, SMITH JR, et al. Anticonvulsant primary and secondary prophylaxis for acute ischemic stroke patients: a decision analysis[J]. Stroke, 2021, 52(9): 2782-2791.
[35]MIGDADY I, RUSSMAN A, BULETKO AB. Atrial fibrillation and ischemic stroke: a clinical review[J]. Semin Neurol, 2021, 41(4): 348-364.
[36]WOLLER SC, STEVENS SM, KAPLAN D, et al. Apixaban compared with warfarin to prevent thrombosis in thrombotic antiphos-pholipid syndrome: a randomized trial[J]. Blood Adv, 2022, 6(6): 1661-1670.
[37]KIMURA S, TOYODA K, YOSHIMURA S, et al. Practical "1-2-3-4-Day" rule for starting direct oral anticoagulants after ischemic stroke with atrial fibrillation: combined hospital-based cohort study[J]. Stroke, 2022, 53(5): 1540-1549.

相似文献/References:

[1]何　俊　夏　鹰　陈焕雄　颜　山.Solitaire AB支架机械取栓治疗急性颅内动脉闭塞[J].中国临床神经外科杂志,2015,(08):466.[doi:10.13798/j.issn.1009-153X.2015.08.007]
　HE Jun,XIA Ying,CHEN Huan-xiong,et al.Curative effects of mechanical embolectomy with Solitaire AB stents on acute cerebral infarction[J].,2015,(07):466.[doi:10.13798/j.issn.1009-153X.2015.08.007]
[2]喻　健　王海嵘　潘曙明 综述　葛勤敏 审校.急性缺血性脑卒中机械取栓术的研究进展[J].中国临床神经外科杂志,2015,(08):503.[doi:10.13798/j.issn.1009-153X.2015.08.023]
[3]闫忠军　徐东为　胡　焱　张玉凯　杨建龙.急性缺血性脑卒中的治疗体会[J].中国临床神经外科杂志,2017,(08):591.[doi:10.13798/j.issn.1009-153X.2017.08.025]
[4]黄昌恒　于耀宇　姚自同.急性缺血性脑卒中机械取栓术中应用替罗非班效果的Meta分析[J].中国临床神经外科杂志,2019,(09):527.[doi:10.13798/j.issn.1009-153X.2019.09.005]
　HUANG Chang-heng,YU Yao-yu,YAO Zi-tong.Meta-analysis of impact of tirofiban on clinical effect of mechanical thrombectomy on acute ischemic stroke[J].,2019,(07):527.[doi:10.13798/j.issn.1009-153X.2019.09.005]
[5]罗　宽　周赤忠　潘德锐　乔　木　胡　蝶　段玲俐.动脉溶栓联合机械取栓治疗急性缺血性脑卒中[J].中国临床神经外科杂志,2019,(09):560.[doi:10.13798/j.issn.1009-153X.2019.09.017]
[6]孙　兵　丁鸭锁　常　浩.Solitaire支架取栓术治疗急性缺血性脑卒中的疗效[J].中国临床神经外科杂志,2019,(12):764.[doi:10.13798/j.issn.1009-153X.2019.12.016]
[7]王　英　杜丽英.完善绿色通道及取栓流程对急性缺血性脑卒中病人神经功能的影响[J].中国临床神经外科杂志,2019,(12):769.[doi:10.13798/j.issn.1009-153X.2019.12.019]
[8]韩冰莎　李　娇　李　翔　栗艳茹　张　磊　赵敬河　冯　光.脑氧饱和度监测目标导向治疗在前循环急性缺血性脑卒中机械取栓术后管理的效果[J].中国临床神经外科杂志,2020,(02):73.[doi:10.13798/j.issn.1009-153X.2020.02.004]
　HAN Bing-sha,LI Jiao,LI Xiang,et al.Effects of targeted therapy under direction of monitoring cerebral oxygen saturation on patients with acute ischemic stroke of anterior circulation undergoing mechanical thrombectomy[J].,2020,(07):73.[doi:10.13798/j.issn.1009-153X.2020.02.004]
[9]吴小兵　杨旭森　洪　宇.球囊扩张在急性缺血性卒中合并原位狭窄中的处理体会[J].中国临床神经外科杂志,2021,26(07):544.[doi:10.13798/j.issn.1009-153X.2021.07.016]
[10]赵曰圆,马廉亭.急性脑梗塞（急性缺血性脑卒中）的治疗新方法——机械取栓（拉栓）[J].中国临床神经外科杂志,2022,27(05):431.[doi:10.13798/j.issn.1009-153X.2022.05.039]

备注/Memo

备注/Memo:
（2023-12-12收稿，2024-01-08修回）
基金项目：无锡市卫生健康委科技计划（T202347）；无锡市科协软科学研究课题（KX-24-C09）
通信作者：邬幼萍，Email：Wuyouping1980@163.com
更新日期/Last Update: 2024-07-30