| BackgroundAcute ischemic stroke(AIS),which is more common than hemorrhagic stroke,is caused by a clot or occlusion of a cerebral artery and is characterized by a sudden loss of blood circulation to the brain region,leading to a corresponding impairment of neurological function.According to the latest global burden of disease research data,the incidence of AIS is on the rise in China and has now become the first and second common cause of death in China and the world.The treatment methods for AIS are relatively limited,mostly are thrombolysis or interventional therapy within the treatment time window.With the development of thrombectomy equipment and technological progress,intravascular therapy has significantly improved the recanalization rate and reperfusion degree.However,due to the occurrence of various complications after thrombectomy,the rate of good postoperative prognosis is only 50%.In order to improve the rate of good prognosis,the current research focuses on perioperative severe management after thrombectomy,and many guidelines and consensus have been concerned about this aspect.As an important part of severe management,multimodal monitoring has naturally become a research hotspot in the field of cerebrovascular disease.Common monitoring methods include Intracranial pressure(ICP)monitoring and Cerebral electrical impedance(CEI)monitoring.ICP is considered as the core monitoring parameter in the intensive care management of AIS patients,and the significance of ICP monitoring has been recognized.Perturbative index(PI)is a monitoring index of CEI,which can continuously reflect the change of brain edema,quantify the degree of brain edema,and is also a useful indicator to reflect the change of hematoma volume.Early identification of high-risk patients with complications by means of critical surveillance and timely intervention measures are of great importance for improving the rate of good prognosis and reducing mortality.ObjectiveTo analyze the correlation between ICP monitoring and electromagnetic PI monitoring index,and to explore the early warning effect of electromagnetic PI monitoring on complications.MethodA total of 76 patients with AIS after mechanical thrombectomy admitted to the Neurosurgical Intensive Care Unit of our hospital from January 2018 to December 2020 were selected as the research subjects.All patients received invasive ICP monitoring and electromagnetic PI monitoring.1.According to the average ICP of postoperative patients on day one will be divided into normal ICP group(ICP<15 mm Hg,1mm Hg = 0.133 k Pa),mildly increased ICP group(15≤ICP≤22mm Hg)and moderate severely increased ICP group(ICP > 22 mm Hg),according to the real-time change trend of ICP a step-wise treatment,each group were given conventional support treatment,including ECG monitoring,nourish nerve,improve blood circulation and to maintain homeostasis,etc.Every 1 h recording an ICP and PI data,and collect the patient’s general information,including gender,age,hypertension,diabetes,atrial fibrillation,TOAST etiology classification,intracranial vascular occlusion,time from onset to arterial puncture,time to recanalization from puncture to vessel,and the baseline Glasgow coma scale(GCS),the baseline of the US national institutes of health stroke scale(NIHSS)scores,baseline Alberta stroke project early CT scores(ASPECTS),baseline collateral circulation score,take bolt number,bolt postoperative systolic blood pressure levels and to decompressive craniectomy(DC)implementation,comparing the differences in various indicators between the groups.The correlation between PI and ICP was analyzed by Pearson correlation method.Receiver operating characteristic curve(ROC)was drawn to determine the efficacy of PI in diagnosing ICP increase(ICP > 22 mm Hg).2.Patients were divided into the decompressive craniectomy group and the non-decompressive craniectomy group according to whether DC was performed.Univariate analysis and multivariate Logistic regression analysis were used to explore the influencing factors of the implementation of DC,draw ROC curve,and evaluate the role of PI in the early warning of DC in patients after AIS mechanical thrombectomy.3.Patients were divided into hemorrhagic transformation group(HT group)and non-hemorrhagic transformation group(NHT group)according to whether there is an occurrence of hemorrhagic transformation.Univariate analysis and multivariate Logistic regression analysis were performed to explore the influencing factors of HT occurrence,and ROC curve was drawn to evaluate the role of PI in early diagnosis of HT in patients after AIS mechanical thrombectomy.Statistical software SPSS 26.0 was used for data processing,and graphing software Graph Pad Prism 8.0 was used for drawing.Result1.The normal ICP group,mildly increased ICP group and moderate severely increased ICP group between baseline GCS score,baseline NIHSS score,baseline monitoring ASPECTS score,the percentage of DC and PI value differences were statistically significant(all P < 0.01),Pair comparison between groups normal ICP and moderate severely increased ICP showed that baseline GCS score,baseline NIHSS score and baseline Aspects score were with statistically significant(all P < 0.05).There were statistically significant differences in PI monitoring values among the three groups(all P < 0.01).Pearson correlation analysis showed that there was a significant negative correlation between PI and ICP(r =-0.716,P< 0.001).The area under the ROC curve for PI diagnosis of increased ICP(ICP > 22 mm Hg)was 0.88,the 95% confidence interval(95%CI)was 0.802 to 0.952,and the optimal cut-off value was 120.5,with a sensitivity of 87% and specificity of 74%.2.The patients with decompressive craniectomy group and non-decompressive craniectomy group,compared to arterial puncture time,targeted to the recanalization time,baseline ASPECTS,baseline GCS score,score and baseline NIHSS score difference had statistical significance(P < 0.05),decompressive craniectomy group had a significantly higher ICP than non-decompressive craniectomy group,were 25.2±6.5,17.2±5.1mm Hg(P< 0.001),and decompressive craniectomy group had a significantly lower PI than nondecompressive craniectomy group,were 121.7±12.2,133.9±16.1(P < 0.001);Multivariate Logistic regression analysis showed that baseline NIHSS score(P=0.004,OR=1.277,95%CI1.082～1.508)and ICP(P < 0.001,OR=1.175,95%CI 1.084～1.274)were independent risk factors for DC.Baseline Aspects score(P=0.010,OR=0.615,95%CI 0.424～0.892)and PI(P=0.001,OR=0.940,95%CI 0.906～0.976)were the protective factors affecting the implementation of DC;The AUC of ICP early warning patients with DC was 0.893(95%CI was 0.816～0.971),the best cutoff value,sensitivity,specificity,Youden index,positive predictive value and negative predictive value were 19.5,89.1%,80.0%,0.691,0.872 and0.828,respectively.The AUC of PI early warning patients with DC was 0.833(95%CI0.734～0.931),and the optimal cutoff value,sensitivity,specificity,Youden index,positive predictive value and negative predictive value were 134.0,85.4%,71.4%,0.574,0.827 and0.792,respectively.3.Comparing the HT group and NHT group patients,time from puncture to recanalization,systolic blood pressure level after thrombectomy,the baseline aspects of the section,the baseline NIHSS score,the ratio of the cording ratio of 3,and the baseline lateral branch cycle score were statistically significant(all P < 0.05).PI in HT group was significantly higher than that in NHT group(143.8±13.8,124.9±13.0,P < 0.001).Multivariate Logistic regression analysis showed that,time from puncture to recanalization(P=0.009,OR=1.045,95%CI 1.011 ～ 1.080),more than 3 times of mechanical thrombectomy(P=0.018,OR=2.754,95%CI 0.729～10.407),systolic blood pressure level after mechanical thrombectomy(P=0.010,OR=1.063,95%CI 1.015 ～ 1.114)and PI(P=0.004,OR=1.151,95%CI 1.045 ～ 1.268)were independent risk factors for the occurrence of HT(all P < 0.05).Baseline collateral circulation score(P=0.007,OR=0.329,95%CI 0.073～1.481)was a protective factor for HT(P < 0.01).The AUC of early diagnosis of HT by PI was 0.844(95%CI 0.725～0.963),and the best cutoff value,sensitivity,specificity,Youden index,positive predictive value and negative predictive value were 140.5,80.0%,88.5%,0.685,0.632 and 0.947,respectively.Conclusion1.Electromagnetic perturbative index monitoring has a good correlation with invasive intracranial pressure monitoring,which can be used as an important means to guide clinical monitoring of cerebral edema and intracranial pressure.2.Electromagnetic perturbative index can be used as an effective indicator for early warning of decompressive craniectomy and early diagnosis of hemorrhagic transformation in patients with acute ischemic stroke after mechanical thrombectomy.3.Electromagnetic perturbative index can guide the next targeted treatment measures,and the implementation of noninvasive monitoring has important clinical significance. |
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