| Background: Acute cerebral infarction is a common disease caused by acute thrombosis or blockage of emboli in the cerebral blood vessels,which usually occurs in the elderly.It seriously endanger the life,health of our people.At present,the most effective treatment is the recanalization therapy as early as possible,including intravenous thrombolysis and mechanical thrombectomy.Intravenous thrombolysis within the time window is the first-line treatment for acute cerebral infarction.However,some patients have lost the chance of thrombolysis when admitted to the hospital,because the time window of the intravenous thrombolysis is only 4.5 hours.In addition,intravenous thrombolysis is less effective in blockage of large blood vessels.As a new technology,mechanical thrombectomy has a long time window for thrombus removal.The current time window of anterior circulation infarction is 8 hours and the time window of posterior circulation infarction is 24 hours.Compared with intravenous thrombolysis,mechanical thrombectomy has a higher recanalization rate of large blood vessels and lower hemorrhagic transformation rate.It has become an important treatment method for acute ischemic stroke.Although the successful vessel recanalization rate of mechanical thrombectomy is high,most patients still can not received the treatment in time and a part of the patients can not benefit from it after technically successful recanalization.Whether it is possible to extend the time window for thrombectomy and reduce brain injury or even cerebral hemorrhage after recanalization is a practical issue in current clinical treatment.As a neuroprotective agent,application of magnesium sulfate after acute ischemic stroke can enhance the tolerance of ischemic brain cells to ischemia and hypoxia,which has been proven in animal experiments and some clinical trials.It is an issue that whether magnesium sulfate can be used before surgery to protect the ischemic brain tissue in the infarction area,enhance the clinical efficacy of thrombectomy and furtherly reduce the brain injury after the surgery,which is worth exploring.There is insufficient data on the application of magnesium sulfate in the treatment of acute cerebral infarction with mechanical thrombectomy at present.Objective: This experiment aims to study whether using magnesium sulfate before surgery can improve the prognosis and reduce the occurrence of advance outcomes of patients with acute ischemic stroke who received mechanical thrombectomy or not.Methods: A randomized controlled study was performed on 87 cases of acute cerebral infarction treated at our hospital from September 2018 to January 2020.The patients were divided into two groups randomly,including experimental group and control group.Intravenous infusion of 4 g of magnesium sulfate that was completed within 15 minutes was given to patients in the experimental group,followed by a maintenance dose of 16 g of magnesium sulfate treatment during next 24 hours.All patients received mechanical thrombectomy according to standard procedure of stroke in our hospital.For patients within time window of intravenous thrombolysis,mechanical thrombectomy is directly bridged after intravenous thrombolysis.The clinical and imaging data were calculated and compared to evaluate whether the magnesium sulfate can improve the therapeutic effect of mechanical thrombectomy,including changes of NIHSS scores,90-day m RS scores,and the successful vessel recanalization rates of the two groups of patients.The rates of symptomatic cerebral hemorrhage and mortality of the two groups of patients were calculated and compared to evaluate the safety of the treatment.Result:(1)Sample size results: A total of 87 cases were enrolled in this study,including 42 cases in the expeimental group and 45 cases in the control group.(2)Evaluation of effectiveness of treatment: Postoperative NIHSS score changes(3.81±7.13 vs 2.49±6.53,P=0.046)are statistically significant.The favorable prognosis rates at 90-days(50% vs 36 %,P = 0.173),the successful vessel recanalization rate(80.9% vs 80%,P = 0.911),the first-day NIHSS scores after mechanical thrombectomy(15.12± 9.66 points vs.15.13 ± 8.10 points,P = 0.076),and number of mechanical thrombectomy(2.14±0.73 vs 2.0±0.79,P=0.401)of the patients in two groups are not statistically significant.(3)Evaluation of the safety of treatment: The incidence of symptomatic cerebral hemorrhage(7.1% vs 8.9%,P =1.000),the rate of mortality(16.7% vs 9.8 %,P = 0.512)of the patients in four subgroups are not statistically significant.Conclusion:(1)Compared with simple mechanical thrombectomy,preoperative use of magnesium sulfate combined with mechanical thrombectomy has certain advantages in improving postoperative neurological function,but there is no significant difference in improving long-term prognosis between the two groups.(2)Compared with simple mechanical thrombectomy,preoperative use of magnesium sulfate combined with mechanical thrombectomy does not increase the risk of postoperative hemorrhagic transformation and mortality. |
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