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Objective:A nomogram model was constructed to predict poor prognosis and death risk of mechanical thrombectomy in patients with cardiogenic acute stroke.Methods:Selected 276 patients with cardiogenic acute stroke who were treated by Jiangyin Hospital of Traditional Chinese Medicine from January 2016 to June 2020 who underwent mechanical thrombectomy as the research objects, and recorded their general information and laboratory test results. On the 90th day, the subjects were divided into a good prognosis group ( n=122) and a poor prognosis group ( n=154) according to whether the prognosis was poor or not; according to whether they died, the subjects were divided into the survival group ( n=208) and the death group ( n=68). The differences in patient related data were compared, Logistic regression analysis was used to screen for risk factors for poor prognosis and death, the line chart prediction model was established, and the ability of the column chart model to predict poor prognosis and death was evaluated by using the subject work characteristic (ROC) curve. The independent factors selected by multivariate regression analysis were used as predictors to construct a nomogram model to predict the prognosis of mechanical thrombectomy surgery in patients with cardiogenic acute stroke. The degree of calibration and validity of the nomogram model established in this study Make an evaluation. The measurement data that obey the normal distribution were represented by the Mean ± standard deviation ( ± s), and the two independent sample t test was used for the comparison between groups; The comparison of enumeration data between groups adopted chi-square test. Results:Multivariate logistic regression analysis showed age ( OR=1.165; 95% CI: 1.046-1.284; P=0.001), diabetes ( OR=1.123; 95% CI: 1.021-1.225; P<0.001), hemorrhage transformation ( OR= 2.394; 95% CI: 1.857-2.931; P=0.001), recanalization ( OR=0.418; 95% CI: 0.410-0.552; P=0.001), NIHSS score ( OR=1.502; 95% CI: 1.373-1.631); P=0.001), neutrophil count (NEUT) ( OR=1.024; 95% CI: 1.009-1.139; P=0.001), NEUT/lymphocyte count (NLR) ( OR=1.235; 95% CI: 1.112-1.358; P=0.001), D-dimer ( OR=1.939; 95% CI: 1.328-2.551; P=0.001) was an independent risk factor for poor prognosis in patients with cardiogenic acute stroke; age ( OR=1.153; 95% CI: 1.080-1.226; P<0.001), hemorrhage transformation ( OR=6.330; 95% CI: 4.904-7.754; P=0.001), recanalization ( OR=0.418; 95% CI: 0.323-0.514; P=0.001), NIHSS score ( OR=2.051; 95% CI: 1.784-2.338; P=0.001), NEUT ( OR=1.399; 95% CI: 1.275-1.523; P=0.001), NLR ( OR=1.528; 95% CI: 1.414-1.642; P=0.001), D-dimer ( OR=2.391; 95% CI: 1.948-2.834; P=0.001) was an independent predictor of death in patients with cardiogenic acute stroke. The established nomogram model predicted poor prognosis and the area under the ROC curve of death were 0.814 (95% CI: 0.800-0.828) and 0.842 (95% CI: 0.828-0.857). Conclusions:Age, hemorrhage transformation, recanalization, NIHSS score, NEUT, NLR, and D-dimer are all important for the prognosis of patients with cardiogenic acute stroke by mechanical thrombectomy. Diabetes only has a suggestive effect on poor prognosis. The nomogram model established based on these factors can effectively help clinicians evaluate the prognosis of patients, formulate reasonable treatment plans for them, and improve the prognosis.
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Objective:Based on Logistic regression and XGBoost algorithm, the prediction model of malignant brain edema (MBE) after vascular recanalization of anterior circulation acute great vessel occlusive stroke (ALVOS) was constructed, and the prediction performance was compared.Methods:A retrospective selection of 382 patients with anterior circulation ALVOS who underwent early endovascular treatment (EVT) in our hospital from March 2014 to June 2020 and successfully recanalized the occluded blood vessel was selected. The patients were divided into the training group ( n=267) and the test group ( n=115) according to the ratio of 7∶3 by the random number table method. According to whether the patients had MBE after successful recanalization of the occluded blood vessels, the training group was divided into the MBE group ( n=41) and non-MBE group ( n=226). The baseline data, treatment and brain computed tomography perfusion(CTP) results of MBE group and non-MBE group in training group and test group were compared respectively, including age, admission score of National Institutes of Health Stroke Scale (NIHSS), grade of cerebral collateral circulation, cerebral blood volume, and so on. Logistic regression model and XGBoost algorithm model were used to screen the predictors of MBE in ALVOS patients with occluded vessels successfully recanalized, and the discrimination and calibration of the two models were compared. The measurement data conforming to the normal distribution were expressed as mean ± standard deviation ( ± s), and the independent sample t test was used for comparison between the two groups. Non-normally distributed measurement data were represented by M ( Q1, Q3), using independent sample Mann-Whitney U test. The chi-square test was used to compare the count data between groups. Results:There was no significant difference in baseline data, treatment status, and cranial computed tomography perfusion (CTP) imaging results of the training group and the test group ( P>0.05). The age, admission systolic blood pressure, admission NIHSS score, proportion of hypertension, proportion of cerebral collateral circulation 0-2, proportion of thrombus removal times> 3 times, time from onset to recanalization, and cerebral blood volume (CBV) of MBE group were (68.95±8.04) years old, (146.71±22.73) mmHg, 17(13, 21) min, 87.80%, 82.93%, 68.29%, (365.64±87.83) min, (32.56±5.73) mL/100 g, obvious higher than the non-MBE group [(60.27±7.13) years old, (137.92±19.58) mmHg, 14(10, 18) points, 73.01%, 60.62%, 2.65%, (307.59±74.05) min, (27.49±5.46) mL/100 g] ( P<0.05). The results of Logistic regression model showed that age, NIHSS on admission, grade of cerebral collateral circulation, times of thrombectomy and time from onset to recanalization were the predictors of MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS ( P<0.05). The top five important feature scores of XGBoost algorithm model were cerebral collateral circulation classification 34, embolectomy times 27, onset to vascular recanalization time 25, admission NIHSS score 22, age 16.In the training set, the area under the curve of the Logistic regression model was 0.816(95% CI: 0.749-0.883), and the Hosmer-Lemeshow test showed that χ2=1.547, P=0.438. The area under the curve of the XGBoost algorithm model was 0.856(95% CI: 0.799-0.913), and the Hosmer-Lemeshow test showed that χ2=1.021, P=0.998. Conclusion:Logistic regression model and XGBoost algorithm model had similar prediction performance for MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS, and collateral circulation classification, number of thrombolysis, time from onset to recanalization, NIHSS score on admission, and age could be used as predictors.
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Objective:To investigate the effects of ulinastatin combined with meropenem on immune function, interleukin 2(IL-2), interleukin 4(IL-4), interleukin-6(IL-6), interleukin 10(IL-10) and tumor necrosis factor (TNF-) levels in elderly patients with severe infection.Methods:From January 2016 to June 2018, 60 elderly patients with severe infections admitted to the Second People's Hospital of Lishui were randomly divided into control group(30 cases) and observation group(30 cases). The patients in the control group were treated with meropenem, while the patients in the observation group were treated with ulinastatin on the basis of the control group.Both two groups were treated for 14 days.The therapeutic effects, changes of T lymphocyte subsets, IL-2, IL-4, IL-6, IL-10 and TNF-levels, recovery time of gastrointestinal function and occurrence of systemic inflammatory response syndrome(SIRS) before and after treatment were compared between the two groups.Results:The total effective rate of the observation group(93.33%) was higher than that of the control group(66.67%)(χ 2=6.667, P<0.05). After treatment, CD 3+ [(64.38±3.19)%], CD 4+ [(40.39±2.35)%]and CD 4+/CD 8+ (1.65±0.19) in the observation group were higher than those in the control group[(58.94±3.56)%, (35.47±2.87)% and (1.34±0.14)]( t=6.233, 7.265, 3.834, all P<0.05). The serum levels of IL-2[(126.87±17.49)ng/L], IL-4[(8.98±2.14)g/L], IL-6[(176.89±23.1)ng/L], IL-10[(37.94±12.56)ng/L] and TNF-α[(163.45±17.96)ng/L]in the observation group were lower than those in the control group[(343.27±28.56)ng/L, (19.65±4.56) g/L, (346.37±38.98)ng/L, (83.21±18.56)ng/L and (254.37±23.45)ng/L]( t=35.392, 10.602, 20.476, 11.064, 16.860, all P<0.05). The recovery time of gastrointestinal function in the observation group[(5.31±1.29)d] was shorter than that in the control group[(6.97±1.43)d]( t=4.721, P<0.05), while the incidence of SIRS(13.33%) was lower than that in the control group(43.33%)(χ 2=6.648, P<0.05). Conclusion:Ulinastatin combined with meropenem is effective in the treatment of elderly patients with severe infection.It can improve the immune function of the patients, reduce the levels of IL-2, IL-4, IL-6, IL-10 and TNF-, and alleviate the inflammatory reaction.It is worthy of clinical reference.
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Objective To study the effects of different doses of dexemedetomidine on perioperative stress response in elderly patients undergoing laparoscopic gastrointestinal surgery.Methods Eighty ASA grade Ⅰ or Ⅱ elderly patients,aged≥65 years,falling into ASA Ⅰ or Ⅱ,undergoing laparoscopic gastrointestinal surgery,were randomly divided into four groups:group D1,D2,D3 and C,twenty cases in each.Dexmedetomidine was administrated with a loading dose of 0.5 μg/kg which was infused intravenously over 10 minutes before induction,and was infused intrave nously with a continuous dose of 0.2μg·kg-1 ·h-1,0.5μg·kg-1 ·h-1 and 0.8μg· kg-1 ·h-1 during operation respectively in group D1,D2,D3.In group C,patients were given 7 ml saline which was infused intravenously over 10 minutes before induction,and was infused with a continuous dose of 10 ml/h saline during operation.HR,SBP and DBP were recorded at before infusion (T0),immediately after intubation (T1),5 minutes after pneumoperitoneum (T2),1 hour after pneumoperitoneum (T3),immediately after extubation (T4),10 minutes after extubation (T5).The time of operation and the time of extubation were also recorded.Concentrations of Glu,Cor,E and NE were measured at T0,T1,T3,T5.Results The dosage of remifentanil in group D1,group D2 and group D3 was significantly lower than that in group C,and in group D2 and D3 was significantly lower than that in group D1 (P＜0.05).During T2-T5,HR of group D2 and group D3 was significantly slower than that of group C and group D1 (P＜0.05),and SBP of group D2 and group D3 was obviously lower than that of group C (P＜0.05),respectively.Compared with T0,HR of group C was significantly faster than that at T1-T5 (P＜0.05).Compared with group C,the concentrations of Glu,Cor,E and NE in group D2 and group D3 were extremely decreased (P＜0.05) at T3 and T5,and the concentrations of Cor and NE were obviously lower at T1 (P＜0.05).The concentrations of Cor and NE in group D2 and group D3 were remarkably lower than those in group D1 at T3 and T5 (P＜0.05).The extubation time of group D3 was apparently longer than that of group C (P ＜ 0.05).Conclusion Compared with continuous dose of 0.2 μg·kg-1 ·h-1 and 0.8 μg·kg-1 ·h-1 dexmedetomidine,dexmedetomidine infused intravenously at 0.5 μg· kg-1 · h-1 can more effectively inhibit perioperative stress responses of elderly patients undergoing laparoscopic gastrointestinal surgery,and maintain hemodynamic stability.