Tóm tắt Luận án Studying clinical, subclinical characteristics and some relavant factors of patients with acute cerebral infarctionabovethe cerebellum tent requiringmechanical ventilation

Nội dung tài liệu: Tóm tắt Luận án Studying clinical, subclinical characteristics and some relavant factors of patients with acute cerebral infarctionabovethe cerebellum tent requiringmechanical ventilation

1. MINISTRY OF EDUCATION AND TRAINING MINISTRY OF NATIONAL DEFENSE THE THESIS WAS DONE AT 108 INSTITUTE OF CLINICAL 108 INSTITUTE OF CLINICAL MEDICAL AND MEDICAL AND PHARMACEUTICAL SCIENCES PHARMACEUTICAL SCIENCES Scientific instructors: 1. Prof. PhD. Nguyen Van Thong TRAN THI OANH 2. PhD. Nguyen Hong Quan Reviewer 1: STUDYING CLINICAL, SUBCLINICAL CHARACTERISTICS Reviewer 2: AND SOME RELAVANT FACTORS OF PATIENTS WITH ACUTE Reviewer 2: CEREBRAL INFARCTIONABOVETHE CEREBELLUM TENT REQUIRINGMECHANICAL VENTILATION This thesis will be presented at Institute Council at: Speciality: Neurology Day Month Year Code: 62720147 The thesis can be found at: SUMMARY OF MEDICAL DOCTORAL THESIS 1. National library 2. Library of 108 Institute of clinical medical pharmacological sciences HA NOI – 2019
2. 1 2 INTRODUCTION THE NEWCONTRIBUTIONOF THE THESIS 1. The thesis topic has scientific, practical and topical significance to Stroke is one of the leading causes of death and disability in adults, with contribute to show some clinical, subclinical and imagingcharacteristics of about 80-85% of cerebral infarction. Patients with severe cerebral patients with acute cerebral infarction above the cerebellum tent requiring infarction often have consciousness disorders, loss of ability to protect the mechanical ventilation. airway, sputum congestion, causing respiratory failure. Intubation and 2. Determining a number of factors related to mechanicalventilation of mechanical ventilation for these patients is needed to support breathing to patients with acute cerebral infarction above thecerebellum tent, some protect the airway and ensure adequate oxygen supply to brain cells. prognostic factors of mortality and prognosis ofgood functional state mRS Although the proportion of patients with right ventilated cerebral infarction 0-3 at the time of 1 year. This will helpclinicians predict and prescribe is not high (10-16%), the prognosis is very poor. All patients have severe timely treatment intervention. clinical circumstances, complex evolutions, need many positive treatments but high mortality. The death rate in the hospital is 35-75%. The patients THE STRUCTURE OF THE THESIS who survived are mostly with severe neurological sequelae and dependent. The thesisconsists of130pages: 2pagesof introduction, 36pages of There have been many studies in the world and in the country about overview, 13pages of subjects and methods, 33pages ofresearchresults, patients with cerebral infarction in general but there have not been many 43pages of discussion, 2pages of conclusionsand 1 page of suggestion, 40 studies on patients with mechanical ventilation with cerebral infarction tables,13 charts, 9 images, 1 figures and 148 references. about factors related to ventilation indications and prognostic factors in these patients. Chapter 1 - OVERVIEW Therefore, we conducted the subject: "Studying clinical, subclinical characteristicand some relevant factors of patients with acute cerebral 1.1. Physiology of cerebral infarction infarction above the cerebellum tent requiring mechanical ventilation" A cerebral infarction occurs when the amount of brain blood falls below with two objectives as follows: 18–20 ml / 100g brain / minute, the centre of the infarction is the necrotic 1. Description of clinical, subclinical characteristics and some factors area with a blood flow of 10-15ml/100g brain/minute, around this area related to mechanical ventilation of patients with acute cerebral (Penumbra area) has a blood flow of 20-25ml/100g brain / minute, infarction above the cerebellar tent. although brain cells are still alive but inactive. The area cells die over a few hours and are different for every patient. This is the window time for 2. Identify some of prognostic factors of patients with acute cerebral reperfusion treatment interventions. Treatment measures to save this area. infarction above the cerebellum tent requiring mechanical ventilation. 1.2. Edema in cerebral infarction
3. 3 4 Cerebral edema in a large cerebral infarction causes increased 1.3. Indications and role of mechanical ventilation in patients with intracranial pressure, which can lead to a brain hernia, aggravate cerebral stroke neurological deficiencies and high mortality if left untreated. The clinical The most common causes of hypoxemia in brain stroke patients may be development of cerebral edema in patients with massive cerebral infarction due to partial obstruction of the airways due to sputum stagnation, can be divided into 3 levels: fulminant (within 24-36 hours), slowly (over respiratory depression and hypoventilation, choking pneumonia and several days), or initial acute course then descending (about a week). collapse. In these cases, mechanical ventilation helps improve blood Cytotoxic Edema: Once clogged, there is a stop of oxygen exchange in the oxygenation, maintain oxygenation to the brain and reduce intracranial damaged area which leads to the cell losing energy, losing the function of pressure, but excessive ventilation should be avoided. SpO2 target> 94% the transport membrane, the ion pump stops working, Na + from outside and pCO2 35 - 40 mmHg. In patients stroke with impaired consciousness, spills into the cell, dragging water causes the cell to swell causing cytotoxic or signs of brain stem dysfunction, decreased oropharyngeal motion and edema. This type of edema does not respond to anti-edematous drugs airway reflex loss are at high risk of choking pneumonia. Intubation for this according to the osmotic mechanism. patient is necessary to protect the airway and prevent choke complications. Vasogenic Edema: Occurs 4 to 12 hours after embolization, due to a Some patients have coma, disorders of breathing, have apnea, intubation profound change in the endothelial lining of the capillaries, stagnation of and mechanical ventilation to ensure respiration, ensure oxygen to the brain glycogen in stellar cells, causing bulging star cells, breaking the tight bonds and body to prevent brain edema progression. between intracellular cells tissue and between endothelial cells and stellar The American Heart Association/Stroke Association 2014recommends cells leads to blood barrier brain (BBB), the fluid from the lumen of the for mechanical ventilation in the treatment of acute cerebral infarction: artery is released causing brain edema. Brain edema becomes the strongest Intubation may be considered for patients with decreased levels of on the third to fifth day and is reduced after one to two weeks. This type of consciousness resulting in poor oxygenation or impaired control of edema responds to anti-edematous drugs according to the osmotic secretions. mechanism. 1.4. Hyperventilation and role of pCO2 in treatment intracranial pressure As recommended by the American Heart Association/American Stroke Reducing pCO2 is known as a cerebral artery contraction that reduces Association in 2014, the signs predict malignant cerebral edema and poor cerebral blood flow leading to a reduction in intracranial pressure, mainly prognosis on cranial CT include increased mid-cerebral artery photon, dot due to changes in pH around the blood vessels. The effect of reducing sign on film within 6 hours, infarction of one-third or more of the mid- cerebral blood flow is temporary, after 4 hours brain blood flow has been cerebral artery blood supply region, or midline shift push of 5 mm or more restored 90%. In addition, a rapid increase in pCO2 causes a decrease in the on the cranial CT scan in the first 2 days is also associated with increased pH around the blood vessels, causing vasodilation to increase brain blood nerve damage and death early in the acute phase. The American Heart volume and increase intracranial pressure ("rebound hyperemia"). Use Association/American Stroke Association (2014) recommends serial CT hyperventilation should only be used short in cases of life-threatening scans during the first 48 hours of stroke to assess the risk of malignant increase in intracranial pressure, pending surgical intervention. pCO2 brain edema. should be normalized as soon as possible.
4. 5 6 Chapter 2 - SUBJECTS AND METHODS Clinical variables: gender, age, medical history, time of admission, pulse, 2.1. Studying subjects blood pressure, temperature, level of consciousness at admission on Severe cerebral infarction patients above the cerebellum tent were Glasgow scale, NIHSS score, degree of paralysis, language disorder, treated at Strokecenter-Central MilitaryHospital108from 9/2013 – 6/2017. sensory disorders, urinaryincontinence, pupil abnormalities, light reflexes, 2.1.1. Criteria for selecting a patient head-eye deviation, progression of symptoms, related mechanical The patients was diagnosed as stroke according to the World Health ventilation complications. Organization (1989) stroke definition, arriving at the hospital 72 hours Subclinical variables: hematology, biochemistry, coagulation, arterial blood prior to the onset of cerebral infarction. Images of hemispherical infarction gases. on CT/MRI/ Severe nerve damage with NIHSS≥15 score (if the patient was Imaging variables: CT, CTA, DSA: parenchymal, artery damage, midline shift. hospitalized prematurely, the damage on the first CT was unknown, the Variables of treatment outcome: death, live, mRS at discharge, 1 year. patient would be diagnosed for a second time on CT. Patients were divided 2.2.4. Research contents into 2 groups: mechanical ventilation group and non mechanical ventilation Patients were divided into 2 groups: MVgroup and non MVgroup. The group. patients were divided into two groups, the MVgroup and the non MV group. 2.1.2. Exclusion criteria MVis indicated when at least one of the following criteria: Glasgow ≤ 8, loss History of stroke with mRS score> 2 points, patients with severe of reflexes protects airway causing mucus congestion, patients with medical conditions such as liver failure, severe kidney failure, cancer, consciousness disorders, stimulation must use safety drugs strong spirit causes COPD, respiratory depression, patients with respiratory failure, circulatory failure. 2.2. Research methods: Describe the clinical and paraclinical features with analysis and comparison 2.2.1. Study design:Progressive, description, follow-up study between two groups of MV and non MV group to highlight clinical and 2.2.2.Sample size: subclinical characteristics of patients requiring MV. Sample size is determined by formula: Identify factors related to MV, factors related to prognosis of death at p (1-p) n = Sample size to study hospital discharge and mRS 0-3 at 1 year. The supposedly relevant n = Z2 -------- Z2 : At the probability level 95% (Z =1,96) (1-α/2) (1-α/2) variables are included in univariate analysis and logistic multivariate d2 d: The desired accuracy (d = 0,05) regressions to find meaningful prognostic factors. p: Estimated ratio, the rate ofcerebral 2.3. Data analysis infarctionpatients requiring mechanical ventilationin previous studies, p= 0,11. Data processing using SPSS 16.0 software. Description of clinical, subclinical, imaging features: neurological signs → Based on the above formula, the estimated patient sample sizeis 150. on onset, on admission and during hospitalization, intubation designation, In the period of taking data from 9/2013 – 6/2017, we collected 166 subclinical characteristics, imaging, complications during MV, treatments patients including 84 ventilated severe cerebral infarction patients and 82 and outcome. severe cerebral infarction patients without mechanical ventilation. 2.2.3. Research variables
5. 7 8 Analysis of related factors: Chi-square test of qualitative or quantitative Table 3.4. Neurological symptoms onset variables with clustering. Statistically significant variables in Chi-square Non - MV(n=84) test were included in univariate regression analysis. Variables related to Symptoms MV(n=82) p MVand mortality in univariate analysis with significance level p <0,05 n % n % were included in multivariate regression analysis to identify independent Conscious disorders onset 67 79,8 31 37,8 <0,001 prognostic variables. Lips/ coma does not say 53 63,1 41 50 >0,05 2.4. Diagramresearch Hemiplegia in the face 83 98,8 82 100 >0,05 Hemiplegia 84 100 82 100 >0,05 ACUTE ISCHEMIC STROKE Headache 9 9,5 5 8,0 >0,05 - Images of HI on CT/MRI Dizzy - NIHSS≥15if the damage on the first CT is 8 9,5 7 9,1 >0,05 unknown, will be diagnosed for 2nd on CT Vomiting /nausea 14 16,7 3 3,7 <0,05 (n = 166 patients) Urinary incontinence 56 66,7 16 19,5 <0,001 Comment: Disturbances of consciousness, vomiting/nausea, and urinary incontinence were statistically different with p <0,05. ISCHEMIC ISCHEMIC STROKEwithout MV STROKEwith MV  Neurologic symptoms at hospital arrival (n = 82patients) (n = 84patients) Table 3.5. Neurologic symptoms at hospital arrival MV(n=84) Non - MV(n=82) Symptoms p n % n % 1. Description of clinical, 2. Identify some of prognostic subclinical characteristics and factors in patients ischemic Average Glasgow score 10,31 ± 2,02 11,84 ± 1,95 <0,001 some factor related to MV stroke with MV Average NIHSS score 22,82 ± 5,39 19,90 ± 3,73 <0,001 Glasgow point at 51 60,7 27 32,9 <0,001 admission≤10 Clinicalcharac Subclinical Related factors Prognostic factors Related factors of teristics characteristics of MV of mortality mRS 0-3 at 1 year NIHSS point at admission>20 52 61,9 34 41,5 < 0,01 Head-eye deviation 36 42,9 16 19,5 <0,001 Dilated pupils admission 10 11,9 1 1,2 < 0,01 Chapter 3 – RESULTS Language disorders 83 98,8 82 100 > 0,05 Urinary incontinence 62 73,8 4 4,9 <0,001 3.1. Clinical, subclinical characteristics and some factors related to MV in admission patients with acute cerebral infarction above the cerebellar tent. Severe paralysis 78 92,9 64 78 < 0,01 3.1.1. Clinical symptoms (Muscle strength 0/5-1/5)  Neurological symptoms onset Average strength of arm 0,32 ± 0,64 0,62 ± 0,94 < 0,05 Average strength of leg 0,45 ± 0,67 0,87 ± 1,05 < 0,01
6. 9 10 Comment: The Glasgow average score was lower for the MV group than Sum 34 40,5 Time of for the non MV group. The average NIHSS score for MV was higher than ≤ 3 days 13 38,2 tracheostomy for the non MV group. Signs of head-eye deviation met 42,9% in the MV > 3 days 21 61,8 group, higher than the MV group in 19,5%. Severe paralysis ½ people in 2 Mean duration fromintubationtotracheostomy (days) 3,74 ± 1,21 groups are 92,9% MV group and 78% MV group. Mean duration of MV  Some characteristics related to mechanical ventilation ≤ 3 days 31 36,9 Table 3.10. Indication for intubation 4 – 7 days 46 54,8 Indication for intubation n % ≥ 8 days 7 8,3 Glasgow ≤ 8 18 21,4 Average MV time (days) 4,40 ± 2,28 Nerve Protect airway 23 27,4 96,4 Comment: The rate of intubation was mainly in the first and second day Progession of symtoms 40 47,6 after admission. The rate of tracheostomy early 38,2%. The group with MV Respiratory failure, circulatory failure 3 3,6 3,6 time of 4-7 days had the highest rate of 54,8%. Sum 84 100 100 Table 3.12. Arterial blood gas averages the points Comment: Only 3,6% indicated intubation due to respiratory failure, The first day after MV Day 3 after MV circulatory failure. 96,4% indicated intubation related to nerve. Factors (n= 84) (n= 58) pH 7,436 ± 0,057 7,439 ± 0,048 pCO2 36,8 ± 8,9 37,9 ± 6,75 pO2 132,3 ± 54,3 112,8 ± 37,15 HCO3 24,59 ± 4,08 25,99 ± 3,29 Comment: Blood gas factors at the time of day 1 after MV and day 3 after MV had reached the goal. Table 3.15. Complications related to MV Complications n % Chart 3.7. Time of intubation Pneumonia 30 35,7 Table 3.11. Characteristics in mechanical ventilation Reflux 21 25 Characteristics n % Gastrointestinal bleeding 5 5,95 Average intubation time from admission (days) 1,64 ± 0,91 Canyn around bleeding 1 1,2 Intubation in the first day 49 58,3 Re endotracheal intubation 4 4,8 Intubation for the first 2 days 69 82,1 Comment: Common complications: pneumonia 35,7%, reflux 25% Successful extubation 50 59,5
7. 11 12 3.1.2. Image characteristics 3.1.3. Some factors related to mechanical ventilation in patients with Table 3.19. Characteristics of images on CT scan first acute cerebral infarction above the cerebellar tent. MV Non -MV Sum Results of univariate analysis including 12 clinical and subclinical Image characteristics (n=84) (n=82) (n=166) variables with statistical significance related to MV were included in the n % n % n % Hypodensity 60 71,4 47 57,3 107 64,5 multivariate regression analysis. Early brain imaging 5 6 3 3,7 8 4,8 Table 3.30. Factors related to mechanical ventilation in multivariate analysis Unknown damage 19 22,62 32 39,0 51 30,7 Factors OR 95%CI p p >0,05 Ages > 60 0,378 0,137 - 1,045 0,061 Comment: 64,5% of patients had hypodensity at the first CT scan on admission, 30,7% had no damage of images. Conscious disorders onset 5,097 1,752 - 14,832 0,003 Table 3.22. Image of edema brain on CT scan Vomiting /nausea onset 6,586 1,138 - 38,131 0,035 MV Non -MV Sum Urinary incontinenceonset 8,027 2,628 - 24,518 0,000 Image of edema brain (n=84) (n=82) (n=166) Glasgow point at admission≤10 0,888 0,298 - 2,639 0,830 n % n % n % 0,790 0,260 - 2,397 0,677 None 0 0 27 32,9 27 16,3 NIHSS point at admission> 20 Only blurry brain groove 14 16,7 21 25,6 35 21,1 Head-eye deviation 1,992 0,661 - 6,002 0,221 Blurry brain groove and Dilated pupils admission 7,699 0,443 - 133,935 0,161 8 9,5 17 20,7 25 15,1 ventricular collapse Temperature admission> 37,50C 5,228 0,929 - 29,416 0,061 Midline shift 62 73,8 17 20,7 79 47,6 Pules > 90l/p 1,700 0,641 - 4,508 0,287 Sum 84 100 82 100 166 100 Leukocytes > 10G/l 3,212 1,149 - 8,982 0,026 p <0,05 13,511 4,392 - 41,560 0,000 Comment: Image of edema brain differs between the two groups Midline shift > 5mm Table 3.23. Midline shift classification on CT scan Comment:In the multivariate analysis, 5 variables were statistically MV Non - MV significant: onset consciousness consciousness, vomiting/nausea onset, Midline shift (n=62) (n = 17) urinary incontinenceonset, leukocyte > 10G / l, midline shift > 5mm. n % n % Degree 1 9 14,5 8 41,7 3.2. Study some prognostic factors in patients with cerebral infarction Midline shift Degree 2 16 25,8 6 35,3 in upper cerebellum tent with mechanical ventilation classification Degree 3 37 59,7 3 17,6 3.2.1. Clinical outcome p <0,01 Average midline shift(mm) 10,04 ± 4,69 5,25 ± 3,43 p <0,001 Comment: Midline shift difference between the 2 groups p<0,001.
8. 13 14 Dilated pupils admission 21 (72,4) 19 (34,5) 0,001 Loss of light reflection 24 (82,8) 10 (18,2) 0,000 Temperature admission>37,50C 11 (37,9) 6 (10,9) 0,003 AverageSBPadmission 142,79±33,55 145,56 ±21,93 0,65 AverageDBPadmission 85,93 ± 15,47 85,58 ± 14,39 0,918 Averagepulesadmission 89,72 ± 22,22 87,58 ± 19,84 0,653 Pneumonia 7 (24,1) 23 (41,8) 0,108 Comment: Factors with statistical significance: urinary incontinence onset, dilated pupils admission, loss of light refraction, temperature admission Chart3.12. Functional status upon discharge >37,50C Comment: In the MV group, no patients had a level of mRS 1-2. Mortality Table3.33. Some subclinical factors related to clinical outcome at hospital (mRS 6) 34,5%. In the group with no MV, mRS 4-5 was 68,3%. discharge in patients with cerebral infarction in the cerebellum tent with MV 3.2.2. Some of factors related to prognosis of death in patients with Clinical outcome at discharge Factors p cerebral infarction in the cerebellum tent with MV Dead (n=29) Alive(n=55) Table 3.32. Some clinical factors related to clinical outcome at discharge in Leukocytes > 10G/l 18 (62,1) 39 (70,9) 0,409 patients with cerebral infarction abovethe cerebellum tent with MV Blood glucose >11,1 mmol/l 5 (17,2) 5 (9,1) 0,303 Clinical outcome at discharge pCO on the first MV < 35mmHg 12 (41,4) 17 (30,9) 0,337 Factors p 2 Dead (n=29) Alive (n=55) Midline shift >5mm 23 (79,3) 30 (54,5) 0,025 Conscious disorders onset 22 (75,9) 45 (81,8) 0,518 Table 3.34. Some factors are associated with mortality prognosis in Vomiting /nausea onset 5 (17,2) 9 (16,4) 0,918 univariate regression analysis Urinary incontinenceonset 25 (86,2) 31 (56,4) 0,006 Factors OR 95%CI p Average Glasgow score 10,31 ±2,12 10,29 ±2,01 0,967 Urinary incontinenceonset 4,839 1,483 - 15,784 0,009 Glasgow point at admission≤10 18 (62,1) 33 (60) 0,854 Temperature admission>37,50C 4,991 1,609 - 15,480 0,005 Average NIHSS score 22,76 ± 5,65 22,84 ± 5,34 0,951 Dilated pupils admission 5,500 1,998 - 15,139 0,001 NIHSS point at admission> 20 13 (44,8) 36 (65,5) 0,356 Loss of light reflection 16,063 5,290 - 48,778 0,000 Decreased Glasgow ≥ 2 at intubation 18 (62,1) 25 (45,5) 0,173 Midline shift >5mm 3,194 1,125 - 9,070 0,029 Glasgow point ≤8 at intubation 18 (62,1) 28 (50,9) 0,364 Comment: The factors in the table are all related to statistically significant Intubation in the first day 17 (58,6) 32 (58,2) 1,000 mortality outcomes in univariate analysis. Aggravation in the first 48 hours 22 (75,9) 41 (75,4) 1,000 Head-eye deviation 13 (44,8) 23 (41,8) 0,791
9. 15 16 Table 3.35. Some factors related to mortality prognosis in multivariate Chapter 4 – DISCUSSION logistic regression analysis Factors OR 95%CI p 4.1. Clinical, subclinical characteristics and some factors related to MV Urinary incontinenceonset 4,326 1,062 - 17,617 0,041 in patients with cerebral infarction above the cerebellum tent Temperature admission>37,50C 3,087 0,636 -14,967 0,162 4.1.1. Clinical characteristics, imagings Dilated pupils admission 1,149 0,204 -6,481 0,875 - Conscious disorders onset Loss of light reflection 22,426 2,324 - 216,392 0,007 The study results showed that 79,8% of patients with MV had Midline shift >5mm 0,819 0,172 -3,899 0,802 consciousness disorder onset compared with 37,8% in the group without Comment: When analyzing multivariate logistic regression, the factors MV(p<0,001). Santoli (2001) reported 69% of patients had consciousness associated with mortality outcome were statistically significant: urinary disorder onset. In Gupta’s study (2014), 60% of stroke patients had onset in incontinenceonset, loss of light reflection. MV group compared with 12% in non-MVgroup (p <0,05). In major 3.2.3.Some factors related to mRS 0-3 good function at 1 year cerebral infarction, which causes widespread cerebral infarction, some - There are 55 patients discharged. At 1 year after discharge, there were 7 cases of early cognitive impairment due to the influence of the neural patients losing follow-up, 11/48 patients died, 20,3% mRS 0-3. activation network in the lower part of the hypothalamus by damage to the Table 3.39. Some prognostic factors of good functional mRS 0-3 at 1 year hemisphere. in univariate regression analysis - Vomiting/nausea onset Factors OR 95%CI p Vomiting/nausea is an uncommon manifestation of cerebral infarction. Ages > 60 0,102 0,024 - 0,438 0,002 In the study, the group with MVhad the rate of vomiting / nausea was Pneumonia 0,229 0,055 - 0,957 0,043 16,7%, different from the group with MVwithout 3,7% (p <0,05). Gupta Comment:Factors with a negative predictive effect on good functional mRS (2014) showed signs of vomiting in 43,3% of patients with MV and 14,3% 0-3 at 1 year include: ages > 60, pneumonia with non-MV(p <0,05). Signs of vomiting more likely may be due to Table 3.40. Some prognostic factors of good functional mRS 0-3 at 1 year studies conducted in both patients with cerebral infarction and cerebral in multivariate regression analysis hemorrhage. Significant variables related to the good functional mRS 0-3 at 1 year in -Urinary incontinence onset univariate analysis were included in the multivariate regression analysis. The study results showed that urinary incontinencein the MVgroup was Factors OR 95%CI p 66,7% and this sign in the MV group was 17,1%. Doan Thi Huyen (2009) Ages > 60 0,091 0,019 - 0,427 0,002 studied a group of large brain infarcts with the ratio of urinary incontinence was 66,67%. In the study of Nguyen Van Tuyen (2013) also recorded the Pneumonia 0,192 0,038 - 0,962 0,045 rate of urinary incontinencein patients with MVwas 97,01% compared to Comment: When analyzing multivariate logistic regression, the negative the group without MV2,08% (p <0,05). predictive factors giving good results of mRS 0-3 recovery at 1 year of statistical significance include: ages > 60, pneumonia.
10. 17 18 - Glasgow points at admission - Indication of intubation The mean Glasgow score was 10,31 ± 2,02 in the MVgroup and 11,84 ± The study results showed that 96,4% of intubation and MVrelated to 1,95 in the non - MVgroup (p <0,001). 20,2% of MVgroup patients had a nerves (including Glasgow score ≤ 8 was 21,4%, loss of airway protection, score of Glasgow ≤ 8 on admission. In both groups, the proportion of risk of sputum congestion was 27,4% and nerve progression was 47,6%). patients with a score of Glasgow 9-12 was predominant (63,1% in theMV Traditionally, some authors have indicated intubation and MVwhen and 59,8% in the non-MVgroup). The score of Glasgow admission in impaired consciousness with a score of Glasgow ≤8, or consciousness Mengi's study (2018) was 11,5 ± 2,78. preserved but impaired oropharyngeal function,congestion of phlegm. The - The degree of nerve damage conform the NIHSS scale study results showed that 45,2% of patients with a score of Glasgow 9-10 The NIHSS score is an indicator of the severity of nerve damage. The when intubated had neurologic progression, or loss of airway protective average NIHSS admission to hospital in the MV group (22,82 ± 5,39) was reflexes. higher than that in the non-MV group (19,90 ± 3,73), p <0,001. In Santoli’s According to Nguyen Hong Quan (2012), indication ofintubation study (2001), the average NIHSS score was 21,12 ± 5. related to nerves was 85,6%. In published studies, intubation indicated was - Head-eye deviation mostly related to nerves: Gujjar’s study (1998) was 82%; Schielke's study Head-eye deviationusually appear after a large cerebral infarction in the (2005)was 71%; Berrouschot’s study (2000) was 90%; Milhaud'sstudy tent, either due to lesions around the 8th region of the pre-motor region of (2004) was 86%. the upper frontal lobe or due to severe brain damage brain edema leading to - The time of MV brain compression and appearance this sign. Head-eye deviation is a The average MV time was 4,40 ± 2,28 days, the group of MVpatients 4- serious prognosis factor in stroke patients. Research results showed that 7 days accounted for the highest proportion (54,8%). In Berrouschot’s 29,4% of patients showed signs of head-eye deviation, and met a higher study (2000), averageMV time was 172 ± 182 hours (7,17 ± 7,58 days), rate in the MVgroup was 42,9% compared with 19,5% in the non- MV Santoli's study (2001), averageMV time was 8,6 ± 8,8 days. Popat's study group. In the Gupta study (2014), head-eye deviation in the MV group was (2018) averageMV time was 6,5 ± 5,9 days. In massive cerebral infarction, 17,3% and in the non-MV groupwas 10,9%. adverse neurologic events usually occur within the first 48 hours, especially - Signs of mydriasis malignant brain edema, requiring MV. At the end of the period of severe In the MVgroup, 11,9% of patients showed signs of mydriasis, in the cerebral edema, the patient has adequate self-breathing, can stop MV, avoid non -MVgroup, this rate was 1,2% (p <0.01). When there was aggravation prolonged MV, limiting the complications of MV. of neurological deficiencies, the rate of mortality was 47,6% of patients in - Characteristics of arterial blood gases MVgroup. In the Gupta’s study (2014), the group of patients with MVwho The pO2 index on the first day:132,3 ± 54,3 and 112,8 ± 37,15 on day had MVhad the rate of mydriasis abnormalities of 17,3% and the group of 3. This was appropriate because the patients in the study had good MV with 10,9% (p = 0,25). In the Gujjar’s study(1998), the rate of pulmonary ventilation and 96,4%of intubation was related to nerves. mydriasis abnormalities was 16% in mechanicallyventilated cerebral Arterial blood gas on the first day after MV pH 7,436 ± 0,057, pCO2 36,8 infarction patients. ± 8,9 mmHg, on day 3 MVpH 7,439 ± 0,048, pCO2 37,9 ± 6,75 mmHg.