ZerO Degree head positioning In Acute ischemiC stroke (ZODIAC)

大动脉急性发作后即刻“超急性”小时内患者的体位 缺血性中风是护理中一个重要但未被充分认识的方面，可能会影响其病程。 这种最严重的中风形式的治疗和临床结果。自1968年以来，临床症状 在这种人群中，当床头(HOB)升高到30度或30度时，情况会恶化。 更高，而临床改善或症状稳定已注意到与O-HOB定位。 O-HOB临床改善的机制包括良好的重力血流条件和 重新招募侧支血液通道，而在使用溶栓药物治疗的情况下， 血流量的增加可能会使更多的药物到达堵塞的动脉，促进血栓形成 崩溃了。尽管如此，临床界对于什么是体位仍然存在分歧。 最好的。最近的一项临床试验(HeadPoST)未能回答患者头部位置的问题 超急性大动脉卒中患者，主要登记轻度、非卧床性卒中和小卒中 从未被证明受益于O-HOB定位的穿支动脉疾病，以及 脑出血患者；患者也在晚些时候出现症状(7小时后) 这一点，脑组织挽救是可能的。我们领先的血液动力学中风专家团队 在我们的试点工作中已经表明，大动脉的血流量平均可以增加20% Oo-Hob定位的卒中区域，且无颅内压升高 从症状出现起到48小时内逐渐停止。我们还发现肺炎是罕见的。 使用我们广泛试用的方法进行零滚刀定位。我们提出了一种随机对照 头部定位在大型颅脑损伤早期超急性期定位中的应用 动脉缺血性中风可防止神经症状恶化。将采用一种新的协议 可以在当前标准护理要求内执行，用于快速血栓切除术治疗 使用或不使用溶栓药物(n=182)。患者将随机分为两组：1) 0度滚刀定位；或2)30度滚刀定位。我们假设最优滚刀位置可以是 根据干预期间早期神经症状恶化来确定(目标1)，并建议 该实时恶化可以作为减少下游灌注量的替代措施， 潜在地影响有脑梗塞风险的大脑的生存能力。目标2将确认使用OO-HOB 大动脉缺血性卒中的定位在更大的可推广人群中是安全的。 使用这种护理措施作为一种创新的辅助方法具有重要的前景 缺血性中风症状，并最终减少残疾。

Positioning of the patient during the immediate “hyperacute” hours after onset of large artery acute ischemic stroke is an important, yet understudied aspect of nursing care that could impact the course of treatment and clinical outcome in this most severe form of stroke. Since 1968, clinical symptom worsening has been documented in this population when the head of bed (HOB) is elevated to 30o or higher, while clinical improvement or symptom stability has been noted with 0o-HOB positioning. Mechanisms for 0o-HOB clinical improvement include favorable gravitational blood flow conditions and recruitment of collateral blood channels, while in the case of treatment with clot-busting medications, increased blood flow may allow more medication to reach occluded arteries facilitating clot breakdown. Despite this, there remains a divide within the clinical community about what position is best. A recent clinical trial (HeadPoST) failed to answer the question of head positioning for hyperacute large artery stroke patients, enrolling primarily minor, ambulatory strokes with small perforator artery disease that have never been shown to benefit from 0o-HOB positioning, along with intracerebral hemorrhage patients; patients were also enrolled late into symptoms (7 hours) beyond the point where brain tissue salvage is possible. Our team of leading hemodynamic stroke specialists has shown in our pilot work that blood flow can increase as much as 20% on average in large artery stroke territories with 0o-HOB positioning, and that elevated intracranial pressure is absent in the hyperacute phase out to 48 hours from symptom onset. We have also found that pneumonia is rare with 0o-HOB positioning using our extensively piloted methods. We propose a randomized controlled trial of head positioning to determine if 0o-HOB positioning during the early hyperacute phase of large artery ischemic stroke prevents neurological symptom worsening. A novel protocol will be employed that can be executed within current standard of care requirements for rapid thrombectomy treatment with or without clot-busting medications (n=182). Patients will be randomized to one of two groups: 1) 0o-HOB positioning; or, 2) 30o-HOB positioning. We hypothesize that optimal HOB position can be determined by early neurological symptom worsening during the intervention (Aim 1), and propose that real-time deterioration may be a surrogate measure for decreased downstream perfusion, potentially impacting viability of brain at risk for infarction. Aim 2 will confirm that use of 0o-HOB positioning for in large artery ischemic strokes is safe in a larger generalizable population of patients. Use of this nursing measure holds significant promise as an innovative adjunct method to improve ischemic stroke symptoms, and ultimately reduce disability.