| Objective:Cerebral apoplexy, also known as stroke, or cerebral vascular accident, is an acute cerebral vascular disease, with focal neurologic deficits as the common characteristics. The acute cerebral infarction is the most common type clinically, with high incidence, high morbidity and high mortality. The primary causes of acute cerebral infarction are the imbalance of coagulation and fibrinolytic system and platelet activation. The mild hypothermia state has obvious protective effects on nervous system, and the mild hypothermia treatment has been widely used for heart disease, cardiopulmonary resuscitation and neonatal hypoxic ischemia encephalopathy, etc. This study explored the clinical effect of the mild hypothermia treatment by monitoring coagulation function in patients with acute cerebral apoplexy treated with mild hypothermia through thrombus elasticity map, and evaluated the monitoring of thrombus elasticity map on the coagulation function in patients with acute cerebral apoplexy.Methods:1. Mild hypothermia treatmentThe control group was received conventional therapy by reducing intracranial pressure and cerebral edema, promoting cells metabolism and preventing complications. After admission, the observation group was received mild hypothermia therapy on the basis of conventional therapy. By using Meidishi Ⅱ type ice blanket instrument (Gemma company, the United States), as well as taking acetaminophen and alcohol wipe bath, body temperature dropped rapidly to 33-34℃. At the same time, the hibernate nondepolarizing agent(500 ml 0.9% saline+100 mg promethazine+100 mg chlorpromazine+300 mg Muscle-Ning) was intravenously infused continually according to patients’ blood pressure, heart rate and muscle tension. After 72h hypothermia treatment, stopping drug first, and then remove carpet and ice cap, with recovery at the speed of 1℃/24h.2. The clinical curative effectThe neural function defect score was evaluated by using the national institutes of health stroke Scale (NIHSS) standards. The stroke function disability score was evaluated by using Modified Rankin Scale (Modified Rankin Scale, MRS) standards. The degree of nerve function defect was indicated higher and the neural functional recovery effect was poorer with the score value increased. Patients were evaluated the degree of nerve function defect before and after 1 month of mild hypothermia therapy, with the difference calculated before and after. Cure:the reduction of NIHSS score> 90%, Excellent:the reduction of NIHSS score46%-90%, effective:the reduction of NIHSS score 18%～45%, uncured:the reduction of NIHSS score< 18%.Total effective rate%=cure rate%+excellent rate%+effective rate%.3. The quality of lifeBy using strict health quality of life score, mainly including:role function, social function, physical function, emotional function and the overall quality of life, etc. The higher score indicated the quality of life of patients in postoperative better enhancing.4. The measurement of thrombus elastic graph parametersBefore and 1 h before the end of treatment, patients were collected venous blood, with 0.109 mol/L sodium citrate solution for anticoagulation, inspection immediately. The thrombosis elastic parameters were determined by Thrombelastograph Analyzer TEG-5000 blood clots tension tester (HaemoscopeCor company, USA). The main parameters included blood coagulation reaction time (reaction time, R), reference value 5～10 min; Haemagglutination formation time (kinetics of clot development, K), reference value 1～3 min. Haemagglutination formation rate (a), reference value 53～72 deg; Thrombus maximum amplitude (maximum amplitude, MA), reference value 50～70 mm; Coagulation index (coagulation index, CI), reference value-3～3.5. Coagulant function index determinationThe prothrombin time (PT), partial thromboplastin time(APTT), D-dimmer, plasma fibrinogen(FIB), and platelet aggregation rate(PAGT) of patients were measured by using automatic blood coagulation analyzer CA-7000 (sysmex corporation, Japan)6. Indicators(1)The analysis of clinical efficacy of two groups; (2) the comparative analysis of nerve function damage condition of two groups between different times; (3) the comparative analysis of stroke function disability condition of two groups between different times; (4) the comparative analysis of the quality of life of two groups before and after treatment; (5) the correlation analysis of NIHSS score of two groups and their quality of life; (6) the statistical analysis of adverse reaction and complications after mild hypothermia treatment; (7) the analysis of thrombus elastic graph parameters of two groups; (8) the analysis of coagulation function index of two groups; (9) the correlation analysis of thrombus elastic graph parameters and coagulation function index and the platelet count.Results:1. The analysis of clinical efficacy of two groupsAfter mild hypothermia therapy, the Mann-Whitney rank and test results showed that the clinical curative effect of observation group was better than the control group, the difference was statistically significant (Z=2.784, P=0.01, P< 0.05). Chi-square test result shows that the clinical total effective rate of observation group was obviously higher than control group, the difference between two groups was statistically significant (χ2= 4.865, P= 4.865, P< 0.05).2. The comparative analysis of nerve function damage condition of two groups between different timesThere was no statistically significant difference (χ2= 1.36, P= 1.36, P> 0.05) on the NIHSS score of two groups before treatment. NIHSS score in the two groups after treatment appeared different degree of reducing trend, and the NIHSS score of observation group was obviously decreased more than control group, after treatment 2 w,3 w, there were obviously differences between two groups (χ2= 2.69, P= 0.03; χ2= 4.52, P= 0.01).3. The comparative analysis of stroke function disability condition of two groups between different timesComparing the MRS rating of two groups before treatment, there was no statistically significant difference comparing (χ2=1.92, P=0.24, P> 0.05). MRS score in the two groups after treatment appeared different degree of reducing trend, and the MRS score of observation group was obviously decreased more than control group, after treatment 2 w,3 w, there were statistically significant differences between these two groups (χ2= 4.88, P= 0.03; χ2=4.46, P= 0.02).4. The comparative analysis of the quality of life of two groups before and after treatmentThe health quality of life questionnaire was investigated regularly for the two groups after treatment, the results showed that there was no statistically significant difference (χ2= 1.62, P= 1.62, P> 0.05) on the quality of life of the two groups before treatment. On the overall quality of life after treatment 2 w,3 w, the score of observation group was significantly higher than the control group (χ2= 5.18, P= 0.03; χ2= 5.23, P= 0.01, P< 0.05).5. The correlation analysis of NIHSS score of two groups and their quality of lifeThe correlation analysis was investigated on the two groups by using Spearman method, and the results showed that the postoperative quality of life of patients was increased along with neural function NIHSS score decreased. There was no obvious correlation on the physical function, role function, emotional function and social function with NIHSS score, but the overall quality of life score was negative correlation with NIHSS score. The recovery condition of observation group was much better than control group, and this difference between two groups was statistically significant (P=0.01, P< 0.05).6. The statistical analysis of adverse reaction and complications after mild hypothermia treatmentThe adverse reaction and complications of 45 patients with acute cerebral apoplexy after mild hypothermia treatment were statistically analyzed, mainly including pulmonary infection, coronary heart disease, stress ulcer, hypertension, atrial fibrillation, brain heart syndrome and type 2 diabetes. The results showed that the adverse reaction and complications of patients with acute cerebral apoplexy after mild hypothermia treatment were obviously lower than before treatment, the differences between two groups were statistically significant (t=4.89, P=0.02, P<0.05).7. The analysis of thrombus elastic graph parameters of two groupsBefore the treatment, thrombus elastic figure TEG parameter R and K value of two groups were both small, and a values, MA and CI value were big, and there were no statistical difference between the two groups (P>0.05). The R value and K value of two groups were both significantly increased before treatment and at 1 h before the end of treatment, and a value, MA and CI value were significantly decreased, the difference between two groups was statistically significant (P<0.05).8. The analysis of coagulation function index of two groupsBefore the treatment, PT and APTT value of coagulant function index of two groups were both small, and D-dimer value, FIB and PAGT values all were large, and there were no statistical differences between the two groups (P>0.05). The PT value and APTT value of two groups were both significantly increased before treatment and at 1 h before the end of treatment, and D-dimer value, FIB and PAGT value were significantly decreased, the difference was statistically significant (P< 0.05).9. The correlation analysis of thrombus elastic graph parameters and coagulation function indexThe R and K value were positively correlated with PT, APTT (P<0.05), negatively correlated with D-dimer, FIB and PAGT value (P<0.05, P<0.01); a value, MA value, and CI value were negatively correlated with PT, APTT (P<0.05), positively correlated with D-dimer, FIB and PAGT value (P<0.05, P<0.01).Conclusion:Mild hypothermia combined with conventional therapy for patients with acute ischem ic stroke, can accelerate the improvement of clinical symptoms,obviously improve th e nerve function after treatment, and can make the quality of life of patients increase, and there is a strong correlation between NIHSS score of the stroke scale and quality of life. The application of TEG can effectively monitor the change of coagulation func tion, which can not lead to the disorder of coagulation function, and there is a strong c orrelation between TEG parameters and coagulation function indicators, platelet count and other indicators. TEG monitoring mild hypothermia has significant improvement on the blood coagulation function of patients with stroke, it can be used as a new treat ment plan which is worthy of clinical extension. |
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