| Objective:To observe the safety and effectiveness of selective cerebral hypothermia combined with mechanical thrombectomy in the treatment of acute ischemic stroke（AIS）,and analyze the factors affecting the clinical prognosis;To compare the neuroprotective effects of selective hypothermia and recombinant human erythropoietin（EPO）on acute ischemic stroke;To analyze the predictive value of D-dimer（D-D）for acute large vessel occlusion stroke and the role of complement as a biomarker of the prognosis of acute ischemic stroke;To provide clinical practice basis for evaluation,precise treatment and prognosis prediction of acute ischemic stroke.Methods:A randomized design was adopted.Forty-eight samples were collected and divided into four groups at a ratio of 1:1:1:1:blank control group（normothermic group）,positive control group（normothermic EPO group）,low-dose observation group（hypothermia group A）and high-dose observation group（hypothermia group B）.The normothermic group did not receive hypothermic perfusion.In the normothermic EPO group,4000U EPO was injected into the artery through the catheter or microcatheter.In hypothermia group A,5ml/kg of 4℃normal saline was infused through the catheter or guide tube,and in hypothermia group B,the perfusion dose was 10ml/kg.All the enrolled patients were moved to the neurological intensive care unit after operation,and were treated with antiplatelet aggregation,blood pressure control,statins and supportive treatment.Collect the clinical data of all patients,including age,sex,weight,blood prVessure,blood glucose,risk factors of vascular disease（hypertension,hyperlipidemia,hyperglycemia,smoking,atrial fibrillation,coronary heart disease）,preoperative temperature,onset time,whether intravenous thrombolysis is performed before surgery,anesthesia methods（local anesthesia,general anesthesia）,vascular puncture time,vascular occlusion site,ASITN/SIR score,vascular recanalization time,m TICI classification of vascular recanalization Operation method（stent or thrombus extraction）,whether stent is implanted during operation,conversion rate of symptomatic bleeding,NIHSS score（before operation,1 day after operation and 3 days after operation）,laboratory test results（preoperative D-dimer,preoperative and postoperative blood routine,liver and kidney function,electrolyte,blood glucose,blood coagulation function,complement）,cerebral infarction volume and complications（shivering,blood coagulation disorder,pulmonary infection,urinary tract infection）3 days after operation Clinical outcome（improvement,ineffectiveness,deterioration,death）,90 day m RS score.On this basis,the brain temperature of each hypothermic group was collected immediately after reperfusion,10 minutes after hypothermic perfusion,and after hypothermic perfusion.NIHSS score,cerebral infarction volume 3 days after operation,symptomatic hemorrhage conversion rate,and90 day m RS score were analyzed and compared among the groups before and after treatment.To analyze the predictive value of preoperative D-dimer for acute large vessel occlusion and the correlation between complement level and90 day m RS score.Results:（1）The baseline data of normothermic group,normothermic EPO group,normothermic group A and normothermic group B were compared in terms of gender,age,weight,preoperative temperature,onset time,blood pressure,blood glucose,blood lipid,vascular disease risk factors,blood coagulation function,vascular puncture time,vascular recanalization time,vascular occlusive sites（internal carotid artery,vertebral artery,basilar artery,middle cerebral artery）,complement,D-dimer,surgical methods,anesthesia methods,etc,The differences were not statistically significant（P>0.05）and were comparable.（2）Intra group comparison:NIHSS scores in the normothermic group were compared before operation,1 day after operation,and 3 days after operation,with a statistically significant difference（P<0.05）,while the complement levels were compared before operation,1 day after operation,and 3 days after operation,with no statistically significant difference（P>0.05）.NIHSS scores and complement levels in normothermic EPO group,hypothermic A group and hypothermic B group were statistically significant（P<0.01）before operation,1 day after operation and 3 days after operation.Comparison between groups:The volume of cerebral infarction,symptomatic hemorrhage conversion rate,and 90-day m RS score in hypothermia group A,hypothermia group B,and normothermia EPO groups were lower than those in normothermia group 3days after operation（P<0.05）.The cerebral infarction volume,symptomatic hemorrhage conversion rate,and 90-day m RS score in the two hypothermia groups were lower than those in the normothermic EPO group 3 days after operation（P<0.05）.The volume of cerebral infarction 3 days after operation in hypothermia group B was significantly lower than that in hypothermia group A（P<0.01）,but there was no significant difference in symptomatic hemorrhage conversion rate and 90-day m RS score between the two groups（P>0.05）.（3）The systolic blood pressure,heart rate,peripheral blood oxygen saturation,HCT,K+,Na+,Ca2+levels in normothermia group,hypothermia group A and hypothermia group B were compared with those at different time points before and after surgery,and there was no significant difference（P>0.05）.HCT in the normothermic EPO group was higher 1 day after operation than that before operation（P<0.05）,and there was no statistical significance 3 days after operation compared with that before operation.（4）The brain temperature of each hypothermic group decreased significantly at each time point after hypothermic perfusion（P<0.01）.Compared between groups,the brain temperature（basic brain temperature）of hypothermic group A and hypothermic group B was at the same level immediately after reperfusion（P>0.05）,and there was a significant difference in brain temperature after 10minutes of perfusion and after perfusion（P<0.01）.（5）Time of onset,time of blood vessel puncture,time of vessel recanalization,brain temperature and stent implantation during operation were all risk factors for cerebral infarction volume.The time of onset,the time of blood vessel puncture,the time of blood vessel recanalization,brain temperature,the mode of operation,and the mode of anesthesia were all risk factors for the transformation of symptomatic cerebral hemorrhage.Time of onset,time of vascular puncture,time of vascular recanalization,brain temperature,blood pressure level,blood glucose level and vascular disease are all risk factors of90-day m Rs score≥3 points.（6）ROC curve results showed that NIHSS score and D-dimer had high value in predicting acute large vessel occlusion,with sensitivity of 81.23%and80.22%,specificity of 71.30%and 72.46%,positive predictive value of 81.29%and 81.18%,negative predictive value of 62.49%and 65.52%,and AUC of0.66 and 0.67 respectively.The complement level was positively correlated with the 90-day m RS score（r=0.544,P<0.01）.Conclusions:1.Selective cerebral hypothermia combined with mechanical thrombectomy can significantly reduce the transformation of postoperative hemorrhage and improve the outcome of neurological function.2.The combination of recombinant human erythropoietin and mechanical thrombectomy is safe and effective in the treatment of acute ischemic stroke.3.Early D-dimer level is an independent predictor of acute large vessel occlusion,and serum complement is a valuable prognostic biomarker for patients with acute ischemic stroke. |
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