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Objective:To investigate the effects of intravascular hypothermia combined with early post-pyloric feeding on the neurological function and prognosis in patients with severe ischemic stroke, and to provide a theoretical basis for clinical decision-making on the optimal nutritional support strategy for patients with severe ischemic stroke during intravascular hypothermia treatment.Methods:This was a retrospective, non-randomized, controlled study. A total of 78 patients with first severe ischemic stroke who were admitted to the ICU of Neurology Department, Xuanwu Hospital, Capital Medical University from January 2018 to December 2021 were selected. General information and clinical data of the patients were collected and grouped according to intrvascular hypothermia combined with nutritional support. Patients were divided into early post-pyloric feeding group of 52 cases and early parenteral nutrition group of 26 cases. The neurological prognosis, disease prognosis, nutritional status and complications related to nutritional support of the two groups were retrospectively analyzed.Results:The Glasgow score at 30th day after intravascular hypothermia in the early postpyloric feeding group was (11.25 ± 4.92) points, which was higher than that in the early parenteral nutrition group (8.40 ± 5.53), and the difference was statistically significant ( t=-2.45, P<0.05). After treatment, the serum total protein and hemoglobin of early postpyloric feeding group were (59.56 ± 5.09) g/L and (131.06 ± 19.58) g/L, respectively, which were higher than those of early parenteral nutrition group (56.52 ± 7.94) g/L and (122.07 ± 17.72) g/L. The difference was statistically significant ( t=-2.03, -1.91, P<0.05). The clinical pulmonary infection score of the early postpyloric feeding group was (7.33 ± 0.96) points, which was lower than that of the early parenteral nutrition group (9.42 ± 2.11). The mechanical ventilation time and ICU stay time were (17.46 ± 10.47) days and (28.89 ± 12.59) days, respectively. Compared with the early parenteral nutrition group (25.77 ± 15.20) days and (37.07 ± 17.15) days, the differences were statistically significant ( t=3.28, 2.83, 2.52, all P<0.05). There were no significant differences in catheter-associated bloodstream infection and ICU hospitalization mortality between the two groups (both P>0.05). Conclusions:Intravascular hypothermia combined with early post-pyloric feeding can improve the nutritional status of patients with severe ischemic stroke, effectively control pulmonary infection, shorten mechanical ventilation and hospital stay, and promote neurological repair.
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Objective:To investigate the effect of constant temperature blankets on intravascular hypothermia for severe traumatic brain injury (sTBI). Methods:A total of 112 inpatients with sTBI from January, 2013 to December, 2018 were reviewed. They were divided into control group (n = 58) and observation group (n = 54) according to whether a self-warming blanket was used. They were assessed with Bedside Shivering Assessment Scale (BSAS). Their dosages of anti-shivering medicine, coagulation and intracranial pressure were recorded. The scores of Glasgow Outcome Scale Extended (GOSE) and the mortality one, six and twelve months after discharge were observed. Results:The incidence and severity were less in the observation group than in the control group (χ2 = 16.212, P < 0.01). The dosage of anti-shivering medicine was less in the observation group than in the control group (t > 1.269, P < 0.05). The hypercoagulation relieved significantly six hours after hypothermia in the observation group, and it was stable twelve hours after hypothermia. For the control group, the hypercoagulation relieved significantly twelve hours after hypothermia, and it was stable 24 hours after hypothermia. The intracranial pressure decreased more in the observation group than in the control group. The GOSE score and the mortality were less in the observation group than in the control group (t > 1.168, P < 0.05) one, six and twelve months after discharge. Conclusion:Application of self-warming blankets in intravascular hypothermia for sTBI may relieve shivering, hypercoagulation and intracranial pressure, to improve the outcome of patients.
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Objective To evaluate the influence of Circle of Willis on intravascular hypothermia. Methods A patient-specific model of the Circle of Willis was constructed based on the CT images and the in vitro perfusion experiment with cold water for 20 ℃ was performed. The water was injected from right intracarotid artery (ICA) to the area of middle cerebral artery (MCA) at the flow rate of 30 mL/min and made the cooling period last 15 min. The cooling and rewarming characteristics in the phantom and fluid around MCA were investigated using thermocouples arranged at 27 and 1 spatial locations. The areas distributed with cold water were further visualized using the dyed solution. Results The cold water from right ICA was mainly distributed to right anterior cerebral artery (ACA), MCA, and posterior communicating artery (PCoA), while only a little part of the water could possibly pass through anterior communicating artery (ACoA) to the left ACA. The nearer the locations to the area with cold water, the faster cooling down and also faster temperature recovery rate would be obtained. Moreover, the phantom temperature distributions were asymmetric around MCA due to the complicated bifurcation structures in this area. Conclusions This physical model is useful for investigating the influence of vasculature on endovascular hypothermia and applicable in designing patient-specific hypothermia therapy.