Nursing Care of a Patient with Acute Cerebral Infarction After Bentall Surgery

doi:10.3969/j.issn.2095-8331.2025.06.025

Abstract：This article summarizes the nursing experience of a patient with acute cerebral infarction (ACI) after undergoing Bentall procedure (Bentall surgery), which includes aortic valve replacement with artificial vessel, ascending aortic replacement, and left and right coronary artery anastomosis. Etiological analysis suggests that factors such as intraoperative vascular injury, hemodynamic changes, preoperative comorbidities, surgical duration, and postoperative blood pressure fluctuations may have contributed to the occurrence of acute cerebral infarction. Case characteristics include: (1) complex secondary cardiac surgery (Bentall surgery after aortic valve mechanical valve replacement), with extracorporeal circulation lasting 117 minutes; (2) multisystem interaction disorders [post-stroke consciousness disorder combined with left heart dysfunction, ejection fraction (EF) of 40%]; (3) high-risk anticoagulation contradictions [platelet count 67×109/L, bleeding risk assessment scale including hypertension, liver and kidney dysfunction, stroke, bleeding, unstable international normalized ratio (INR), advanced age, drug or alcohol combination factors (HAS-BLED score 3)]. Nursing challenges involve resolving conflicts between cerebral perfusion insufficiency and cardiac overload, anticoagulant therapy and bleeding risk, and immobilization needs with early rehabilitation. (1) Establish a 'dual-goal-oriented' circulatory management model, combining pulse index continuous cardiac output monitoring (PICCO) and dynamic balance cerebral perfusion pressure via transcranial Doppler, maintaining systolic blood pressure (SBP) at 120-130 mmHg and cardiac index (CI) > 2.5 L/min/m²; (2) Implement a stepwise brain resuscitation protocol, including mild hypothermia intervention (target temperature 36.0-36.5°C), multimodal awakening (pain stimulation combined with family-induced awakening), and precise dehydration therapy (mannitol administration guided by optic nerve sheath diameter (ONSD)); (3) Establish an 'anticoagulation-rehabilitation' collaborative pathway, adjusting warfarin dosage based on thromboelastography, with INR maintained at 2.0-2.5, while simultaneously conducting bedside three-level rehabilitation training (neuromuscular electrical stimulation combined with protective stepping training). After 5 days of intervention, the patient's level of consciousness improved [Glasgow Coma Scale (GCS) score from 5 to 14], limb muscle strength increased by more than 2 grades (left side 2→4), and no complications such as bleeding or aspiration pneumonia occurred, allowing the patient to be transferred out of the intensive care unit (ICU). This case provides a multidisciplinary, precise nursing model for patients with cerebral infarction following complex cardiac surgery.