[Extracorporeal Membrane Oxygenation Combined With Interventional Thrombectomy for Treating High-Risk Pulmonary Embolism Caused by Protein C Deficiency:Report of One Case].

Hereditary protein C deficiency is a chromosomal genetic disease caused by mutations in the protein C gene,which can lead to venous thrombosis and is mostly related to mutations in exons 4-9 and intron 8.Fatal pulmonary embolism caused by mutations in the protein C gene is rare,and the treatment faces great challenges.This article reports a case of fatal pulmonary embolism caused by a frameshift mutation in exon 8 of the protein C gene and summarizes the treatment experience of combining extracorporeal membrane oxygenation (for respiratory and circulatory support) with interventional thrombectomy,providing a basis for the diagnosis and treatment of this disease.

A prognostic model for interventional thrombectomy in patients with acute ischemic stroke based on a BP neural network, random forest model and decision tree model.

OBJECTIVE: To investigate the predictive effect of a Back propagation (BP) neural network model, a random forest (RF) model and a decision tree model on the prognosis of interventional thrombolectomy for acute ischemic stroke (AIS) patients. METHODS: A total of 255 patients with AIS admitted to the Department of Neurology, Beiliu People's Hospital of Guangxi from March 2018 to February 2022 were retrospectively included, all of whom received interventional thromposectomy. Patients' prognosis was determined by the modified Rankin Scale (mRs) at 3 months after surgery, including the good prognosis group (mRs≤2 points) and the poor prognosis group (mRs 3-6 points). Clinical data of the two groups were collected to explore and screen the factors affecting poor clinical prognosis. Based on the selected influencing factors, the BP neural network, RF model, and decision tree models were established respectively, and their predictive performances were verified. RESULTS: All the three models predicted the same verification set data. The prediction accuracy, sensitivity and specificity of the BP neural network model were 0.961, 0.983 and 0.875, respectively. The prediction accuracy, sensitivity and specificity of the RF model were 0.948, 0.952 and 0.933, respectively. The prediction accuracy, sensitivity and specificity of the decision tree model were 0.882, 0.953 and 0.667, respectively. CONCLUSION: The three prediction models have shown good diagnostic efficacy and stability in the preliminary study of the prognosis of AIS mediated thrombectomy, which has important guiding significance for clinical prognosis assessment and selection of appropriate surgical population. The prediction model can be selected according to the actual situation of patients to provide more efficient guidance for clinicians.

Construction of sensitive index system of nursing quality in patients with acute ischemic stroke patients undergoing interventional thrombectomy / 中国实用护理杂志

Objective:To construct a sensitive index system of nursing quality for patients with acute ischemic stroke patients undergoing interventional thrombectomy, so as to provide a scientific basis for interventional thrombectomy care for acute ischemic stroke.Methods:Taking the "structure-process-result" three-dimensional quality model as the theoretical framework, through evidence-based literature search, the item pool was drawn up, and finally the indicators and their weights at each level were determined by two rounds of Delphi method in December 2021 and January 2022 and analytic hierarchy process.Results:The positive coefficients of the two rounds of inquiries to experts were 0.92 and 1.00, respectively, the authority coefficients were 0.913 and 0.917, and the Kendall coefficients were 0.141 and 0.202, respectively. The final index system consisted of 3 primary indicators, 9 secondary indicators and 50 three-level indicators.Conclusions:The nursing sensitive quality index system for patients with acute stroke patients undergoing interventional thrombectomy constructed in this study has high reliability and scientificity, which can provide target incentives for clinical nurses and provide reference for the development of specialized nursing sensitive quality indicators.

Establishment of emergency-nursing pathway of interventional thrombectomy in acute ischemic stroke.

OBJECTIVE: To establish the emergency-nursing pathway of interventional thrombectomy on acute ischemic stroke (AIS). METHODS: 113 AIS patients who received interventional thrombotomy in conventional emergency model from Aug. 2019 to Feb. 2020 were included as control-group, and 127 patients, who underwent interventional thrombotomy by pathway-based emergency nursing program from Mar. 2020 to Sep. 2020, were classified into observation-group. The time points from admission to recanalization of the two groups, the recanalization rate, and the changes in the neurological impairment scale (NIHSS) scores of the two groups in pre- and post-treatment were compared; Meanwhile, the therapeutic efficacy rate between the two groups was evaluated and compared by modified Rankin Score (mRS) 90 days after discharge. RESULTS: The average time from hospital arrival to femoral artery puncture, the average time of successful femoral artery puncture, and the average time from admission to recanalization in observation-group were remarkably shorter than that of control-group (P<0.05). The recanalization rate of endovascular therapy in observation-group was 92.13%, which was higher than that in control-group (80.53%, P<0.05); The NIHSS score of observation-group after treatment was obviously lower than that of control-group (P<0.05); The curative rate in observation-group was 90.55%, which was higher than that of 79.65% in control group (P<0.05); The satisfaction of observation-group patients with nursing care was 90.55%, which was higher than that of 73.45% in control-group (P<0.05). CONCLUSION: Establishment of emergency-nursing pathway can reduce the time-consuming from admission to vascular recanalization for AIS patients undergoing interventional thrombectomy, increase the recanalization rate, improve the patients' neurological function, and ameliorate the curative rate and nursing satisfaction.