针对性温度管理和急性缺血性中风后血栓切除术 (COTTIS) 的组合:一个试点研究
Jürgen Bardutzky1, Rainer Kollmar2, Forat Al-Rawi3
1Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany juergen.bardutzky@uniklinik-freiburg.de.
Stroke and vascular neurology
|August 23, 2023
概括
快速通过鼻子冷却到35°C是可行的,对于患有大血管封闭性中风的患者进行内血管血栓切除术是安全的. 这种低温策略与血栓切除术相结合,显示出有希望的结果和与标准EVT相比的安全性.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 紧急医疗 紧急医疗
背景情况:
- 由于前部循环大血管封闭 (LVO),急性缺血性中风需要快速干预.
- 内血管血栓切除术 (EVT) 是急性缺血性中风 (LVO) 的标准治疗方法.
- 治疗性低温可能会改善急性中风的结果,但其快速应用需要评估.
研究的目的:
- 评估快速透鼻冷却到35°C的可行性和安全性,在接受EVT的LVO患者中.
- 通过透鼻冷却来确定达到目标温度所需的时间.
- 评估临床,放射学和安全结果.
主要方法:
- 包括接受EVT的LVO发作<24小时的患者.
- 透鼻冷却 (RhinoChill) 启动后立即输管到食道目标温度的35°C.
- 低温维持在表面冷却6小时后的recanalization,然后再加热.
主要成果:
- 达到35°C的目标温度平均在30分钟内达到 (冷却速率为2.6°C/小时).
- 86%的患者通过再通道化达到≤35°C.
- 在国家卫生研究院中风量表 (NIHSS) 上显著改善,并在3个月后获得68%的良好结果 (修改的兰金量表0-2).
- 不良事件 (心肌梗塞,肺炎,出血转变) 与没有低温的EVT可比.
结论:
- 结合性低温和EVT在镇静,通风的LVO患者中是可行的.
- 副作用的发生率与单独使用EVT相似.
- 计划在随机化COACTIS-2试验中进行进一步评估.
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