Cerebral infarction and risk factors in acute type A aortic dissection with arch branch extension

Cerebral Protection With Deep Hypothermic Circulatory Arrest During Total Arch Replacement Using the Arch-First Technique for Acute Aortic Dissection

OBJECTIVES

Stroke remains a serious complication after total arch replacement (TAR). To prevent this, deep hypothermia is commonly employed during TAR. We evaluated the effectiveness of cerebral protection using deep hypothermic circulatory arrest (DHCA) during TAR with the arch-first technique, focusing particularly on patients with acute aortic dissection (AAD).

METHODS

This retrospective study included 109 consecutive patients with AAD who underwent emergency TAR using the arch-first technique under DHCA, and 147 patients with non-ruptured aneurysm who underwent scheduled TAR using the same technique between October 2009 and July 2022. We reviewed these patients for major adverse events, including stroke and 30-day mortality after surgery. We also analyzed the impact of clinical variables and anatomical features on the occurrence of newly developed stroke after TAR in patients with AAD.

RESULTS

A newly developed stroke after TAR occurred in 11 (10.1%) patients with AAD. These were attributed to embolism in eight patients, malperfusion in two patients (including one who had been comatose), and low output syndrome in one patient. A stroke occurred in 3 (2.0%) patients with aneurysm, all due to embolism (P = 0.005). The DHCA time was 37 ± 7 minutes for patients with AAD and 36 ± 6 minutes for patients with aneurysm (P = 0.122). The 30-day mortality rate was 10 (9.2%) for patients with AAD and 2 (1.4%) for patients with aneurysm (P = 0.003). In our multivariable analysis, arch vessel dissection with a patent false lumen (double-barreled dissection) was the only significant predictor of newly developed stroke after TAR for AAD (odds ratio, 33.02; P < 0.001).

CONCLUSIONS

Patients with aneurysm undergoing TAR using the arch-first technique under DHCA experienced significantly better outcomes, in terms of newly developed stroke and 30-day mortality, than those with AAD. Cerebral protection with DHCA during TAR using the arch-first technique continues to be a viable option. Newly developed stroke in patients undergoing TAR for AAD appears to be associated with air emboli deriving from the residual dissection with a patent false lumen in the repaired arch vessels.

Advantages of edaravone dextrosanol in elderly patients with acute cerebral infarction versus edaravone: a preliminary study

OBJECTIVE

To analyze and compare the application advantages of Edaravone and Edaravone Dextrosanol in elderly patients with acute cerebral infarction (ACI).

METHODS

A retrospective analysis of clinical data from 113 elderly AIS patients admitted to our hospital between January 2022 and January 2023 was conducted. Based on the treatment interventions received, patients were divided into a control group (n = 56) and an observation group (n = 57). The control group received Edaravone in addition to routine treatment, while the observation group received Edaravone Dextrosanol in addition to routine treatment. compared clinical outcomes, motor and neurological function, self-care ability, neural damage indicators, inflammatory markers, and adverse reactions between the two groups.

RESULTS

① Total effective rate in the observation group (91.23%) was significantly higher than that in the control group (75.00%) (p < 0.05). ② After treatment, higher FMA and Barthel scores, lower NDS score in observation group vs control group (p < 0.05). ③ After treatment, lower NSE and MMP-9 levels in observation group vs control group (p < 0.05). ④ After treatment, lower IL-1β, IL-6, and hs-CRP levels in observation group vs control group (p < 0.05). ⑤ No significant difference in adverse reaction incidence between groups (p > 0.05).

CONCLUSION

Edaravone Dextrosanol proves effective in treating elderly AIS patients. Compared to Edaravone, it boosts effectiveness, neurological recovery, motor & self-care abilities, and reduces neural damage & inflammation markers. Its safety profile is comparable to Edaravone, without significantly increasing adverse reactions. These findings suggest that Edaravone Dextrosanol is worthy of clinical promotion.

Impacts of evidence-based nursing combined with enteral nutrition on nutritional status and quality of life in acute cerebral infarction patients: A randomized controlled trial

OBJECTIVE

To explore the impacts of evidence-based nursing (EBN) combined with enteral nutrition (EN) on nutritional status as well as quality of life in acute cerebral infarction (ACI) patients.

METHODS

In this randomized controlled cluster trial, 80 ACI patients admitted to our hospital from January 2021 to December 2022 were selected and randomly separated into study group (SG) and control group (CG), with 40 patients in each group. Patients in CG received routine nursing, and patients in the SG received EBN combined with EN. The neurological function, limb movement ability, nutritional status, anxiety and depression, incidence of complications and quality of life between two groups were compared.

RESULTS

After intervention, the NIHSS score in the SG was lower than that in the CG (CG = 5.62 ± 0.56, SG = 3.27 ± 0.33. p < .001). The FMA score in the SG was higher compared with the CG (CG = 52.58 ± 5.32, SG = 68.85 ± 6.87. p < .001). The Hb level, TP level and ALB level in the SG were higher relative to the CG (p < .001). The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores in the SG were lower in comparison with the CG (SAS score: CG = 42.32 ± 4.25, SG = 36.28 ± 3.64; SDS score: CG = 48.27 ± 4.85, SG = 40.06 ± 4.05. p < .001). The incidence of complications in SG was lower than that in CG. Finally, we found that SF-36 scores in the SG in all dimensions were higher than those in the CG (Physiological function: CG = 70.23 ± 7.05, SG = 82.71 ± 8.26. Role function: CG = 66.28 ± 6.64, SG73.39 ± 7.36. Physical pain: CG = 70.67 ± 7.06, SG = 82.69 ± 8.29. General health: CG = 58.74 ± 5.86, SG66.62 ± 6.65. Mental health: CG = 53.68 ± 5.37, SG = 62.39 ± 6.31. Energy: CG = 60.75 ± 6.08, SG = 67.87 ± 6.78. Social function: CG = 76.25 ± 7.25, SG = 85.78 ± 8.59. Emotional function: CG = 61.23 ± 6.15, SG = 75.74 ± 7.56. p < .001).

CONCLUSION

EBN combined with EN can improve the nutritional status and the quality of life in ACI patients compared with the traditional routine nursing, and is suggested as a valuable strategy for clinical management of ACI.