BACKGROUND Cardiac embolism is a common cause of ischemic stroke in young adults.Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus.Early complete resectio...BACKGROUND Cardiac embolism is a common cause of ischemic stroke in young adults.Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus.Early complete resection of giant cardiac myxoma is the key to its treatment and prevention of stroke recurrence.CASE SUMMARY A 42-year-old,previously healthy woman was admitted to the hospital with sudden-onset inability to speak and right-sided hemiplegia.While sweeping the floor 2 h prior to hospital admission,the patient developed sudden inability to express herself or understand what others were saying,accompanied by dyskinesia of the right limb,inability to walk or hold objects,and involuntary choreiform movements of the left upper limb.The patient was diagnosed with cerebral embolism and cardiac myxoma,complicated by left middle cerebral artery occlusion.The acute stroke was treated with intravenous thrombolytic therapy and arterial embolectomy as a bridging therapy to open resection of left atrial cardiac myxoma.The patient condition improved remarkably following initial thrombolysis and embolectomy and subsequently underwent emergency open resection of the atrial cardiac myxoma.She had no recurrence during 1-year follow-up.CONCLUSION Strong consideration should be given to urgent intravenous thrombolysis(rt-PA,alteplase)in young adult stroke patients at the time of hospital admission.The present case demonstrated a highly successful outcome that combined thrombolysis and arterial embolus retrieval as a bridge to early complete resection of a giant cardiac myxoma for both stroke treatment and recurrence prevention.展开更多
背景先天性心脏病患儿行开胸手术后疼痛的规范化管理十分重要,目前尚未形成系统的针对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据。目的对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据进行总结,为临床实践提供循证依据。方法...背景先天性心脏病患儿行开胸手术后疼痛的规范化管理十分重要,目前尚未形成系统的针对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据。目的对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据进行总结,为临床实践提供循证依据。方法系统检索UpToDate临床顾问、BMJ最佳临床实践、国际指南协作网、美国国立指南库、英国国家卫生与临床优化研究所、医脉通指南网、Cochrane Library、PubMed、Web of Science、Embase、CINAHL、万方数据知识服务平台、维普网、中国知网、中国生物医学文献服务系统及美国心脏病协会、美国心血管学会、欧洲心脏病协会、美国疼痛协会、加拿大安大略注册护士协会网站,获取关于先天性心脏病患儿行开胸手术后疼痛管理的临床决策、指南、专家共识、证据总结、系统评价及随机对照试验,检索时限为建库至2025-01-01,进行方法学质量评价后,依据主题对证据提取和汇总。结果共纳入15篇文献,其中指南1篇,专家共识1篇,系统评价3篇,随机对照试验10篇,通过阅读、提取、归纳最终总结了疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略4个方面的26条证据。结论形成先天性心脏病患儿行开胸手术后疼痛管理中关于疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略的最佳证据,可为临床医务工作者提供证据支持,提高临床护理质量。展开更多
文摘BACKGROUND Cardiac embolism is a common cause of ischemic stroke in young adults.Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus.Early complete resection of giant cardiac myxoma is the key to its treatment and prevention of stroke recurrence.CASE SUMMARY A 42-year-old,previously healthy woman was admitted to the hospital with sudden-onset inability to speak and right-sided hemiplegia.While sweeping the floor 2 h prior to hospital admission,the patient developed sudden inability to express herself or understand what others were saying,accompanied by dyskinesia of the right limb,inability to walk or hold objects,and involuntary choreiform movements of the left upper limb.The patient was diagnosed with cerebral embolism and cardiac myxoma,complicated by left middle cerebral artery occlusion.The acute stroke was treated with intravenous thrombolytic therapy and arterial embolectomy as a bridging therapy to open resection of left atrial cardiac myxoma.The patient condition improved remarkably following initial thrombolysis and embolectomy and subsequently underwent emergency open resection of the atrial cardiac myxoma.She had no recurrence during 1-year follow-up.CONCLUSION Strong consideration should be given to urgent intravenous thrombolysis(rt-PA,alteplase)in young adult stroke patients at the time of hospital admission.The present case demonstrated a highly successful outcome that combined thrombolysis and arterial embolus retrieval as a bridge to early complete resection of a giant cardiac myxoma for both stroke treatment and recurrence prevention.
文摘背景先天性心脏病患儿行开胸手术后疼痛的规范化管理十分重要,目前尚未形成系统的针对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据。目的对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据进行总结,为临床实践提供循证依据。方法系统检索UpToDate临床顾问、BMJ最佳临床实践、国际指南协作网、美国国立指南库、英国国家卫生与临床优化研究所、医脉通指南网、Cochrane Library、PubMed、Web of Science、Embase、CINAHL、万方数据知识服务平台、维普网、中国知网、中国生物医学文献服务系统及美国心脏病协会、美国心血管学会、欧洲心脏病协会、美国疼痛协会、加拿大安大略注册护士协会网站,获取关于先天性心脏病患儿行开胸手术后疼痛管理的临床决策、指南、专家共识、证据总结、系统评价及随机对照试验,检索时限为建库至2025-01-01,进行方法学质量评价后,依据主题对证据提取和汇总。结果共纳入15篇文献,其中指南1篇,专家共识1篇,系统评价3篇,随机对照试验10篇,通过阅读、提取、归纳最终总结了疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略4个方面的26条证据。结论形成先天性心脏病患儿行开胸手术后疼痛管理中关于疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略的最佳证据,可为临床医务工作者提供证据支持,提高临床护理质量。
