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Objective:To investigate the application value of transcranial Doppler (TCD) in the prognosis assessment of nerve function in patients with acute cerebral infarction (ACI) after intracranial mechanical thrombectomy.Methods:A retrospective analysis was conducted. The clinical data of 43 patients with acute anterior circulation cerebral infarction who received intra-arterial mechanical thrombotomy for recanalization admitted to Taizhou Central Hospital from January 2018 to December 2019 were analyzed. The modified Rankin scale (mRS) score of patients were followed up by telephone at 3 months after surgery to evaluate the prognosis of neurologic outcome. Patients with mRS score 0-2 were enrolled in the good prognosis group, while those with a score of 3-6 were enrolled in the poor prognosis group. The gender, age, past history, underlying diseases, occluded arteries, atherosclerotic stenosis and bridging treatment, time from onset to reperfusion, blood flow dynamics under TCD at 1 day after thrombectomy, and National Institutes of Health stroke scale (NIHSS) scores before and 1, 7, and 14 days after thrombectomy were compared between the two groups. Multivariate Logistic regression analysis was used to screen the prognostic factors of nerve function at 3 months after mechanical thrombectomy in patients with ACI. The receiver operating characteristic (ROC) curve was drawn to evaluate the prognostic value for neurological function assessed by TCD.Results:Forty-three patients were enrolled in the final analysis, with 23 patients in the good prognosis group and 20 in the poor prognosis group. The recanalization was successfully achieved in both groups without complications. However, the hemodynamics of intracranial arteries evaluated by TCD 1 day after operation in both groups still showed partial or complete occlusion, and the hemodynamics of patients in the poor prognosis group was worse than that in the good prognosis group (poor blood flow: 40.0% vs. 0%, inadequate blood flow: 30.0% vs. 17.4%, good blood flow: 30.0% vs. 82.6%), and the differences were statistically significant (all P < 0.01). Before thrombotomy, there was no significant difference in NIHSS score between the two groups. After thrombotomy, the NIHSS score of the two groups gradually decreased with the extension of time, but the NIHSS score at 14 days after operation of the poor prognosis group was still significantly higher than that of the good prognosis group (10.55±2.93 vs. 4.65±1.70, P < 0.01). Univariate analysis showed that compared with the good prognosis group, the proportion of patients with diabetes and arteriosclerosis stenosis in the poor prognosis group were significantly increased (30.0% vs. 4.3%, 45.0% vs. 17.4%, both P < 0.05), and the time from onset to reperfusion was prolonged (minutes: 385.9±96.2 vs. 294.5±95.1, P < 0.01). Multivariable Logistic regression analysis showed that the therosclerosis stenosis [odds ratio ( OR) = 9.334, 95% confidence interval (95% CI) was 1.092-79.775, P = 0.041] and the reperfusion time ( OR = 1.016, 95% CI was 1.006-1.027, P = 0.002) were associated with prognosis of nerve function at 3 months after mechanical thrombectomy in patients with ACI. ROC curve analysis suggested that the evaluation of intracranial hemodynamics by TCD might be able to predict the prognosis of neurological function in patients with ACI after 3 months of intracranial mechanical thrombectomy, the area under ROC curve (AUC) was 0.768 (95% CI was 0.620-0.917), the sensitivity was 65.0%, the specificity was 87.0%, the positive predictive value was 82.6%, and the negative predictive value was 70.0%. Conclusion:The evaluation of intracranial hemodynamics assessed by TCD is helpful in early judging the prognosis of neurological function in patients with ACI after intracranial mechanical thrombectomy.
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Objective To investigate the clinical efficacy of piracetam combined with edaravone in the treatment of patients with acute cerebral infarction.Methods 120 patients with acute cerebral infarction were selected,and they were randomly divided into control group and observation group according to the digital table,60 cases in each group.The patients in both two groups were treated with mannitol to reduce intracranial pressure,aspirin antiplatelet aggregation,combined with basic nutritional support,active prevention and treatment of complications.The control group was intravenously given piracetam.On this basis,the observation group was intravenously given edaravone injection.Both two groups were treated for 14 days.The clinical curative effect,neurological deficit and self-care ability score before and after treatment were observed,and the indicators of hemorheology before and after treatment were observed.Results Mter treatment,the neurological deficit and self-care ability scores of the two groups were significantly improved(t =3.43,4.12,5.67,6.89,all P ＜ 0.05),the improvements of the observation group were significantly better than those of the control group(t =2.10,4.21,all P ＜ 0.05).The total effective rate of the observation group was 85.00％,which was higher than 70.00％ of the control group,the difference was statistically significant (x2 =4.11,P ＜ 0.05).After treatment,the indicators of hemorheology of the two groups were significantly improved (t =1.43,2.98,2.32,4.56,1.67,2.11,1.46,1.98,all P ＜ 0.05),and the improvements of the observation group were significantly better than those of the control group (t =1.46,2.32,1.67,1.39,all P ＜ 0.05).Conclusion Piracetam combined with edaravone can significantly improve the neurological function,cognitive function and hemorheology of patients with acute cerebral infarction.
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Objective To study the influence of oxy matrine combined with salvia mltiorrhiz on the hepatic fibrosis markers.Methods 60 patients with abnomal prameters of fibrosis level were randomly divided into two groups,30 patients of treatment group treated by salvia miltiorrhiz and oxy matrine,the control group was given liver protectiont treatment,then observed the changes of hepatic fibrosis markers:HA,LN,PCⅢ,and ⅣC.Results A significant decrease of HA,LN,PCⅢ,and ⅣC were observed in the patients treated with oxy matrine and salvia miltiorrhiz(P