摘要
目的探讨上肢远程缺血后适应治疗对急性脑梗死神经功能及预后的影响。方法选取2013年1月—2015年1月郑州大学附属洛阳中心医院诊断为急性脑梗死的患者160例为研究对象,采用随机数字表法分为两组：对照组80例,予以常规药物治疗及正规康复训练;治疗组80例,予以常规药物治疗、正规康复训练及上肢远程缺血后适应治疗。两组患者于治疗前及治疗14 d后进行美国国立卫生研究院卒中量表（NIHSS）评分、经颅多普勒（TCD）检查,治疗3个月后进行改良Rankin量表（mRs）评分。平均随访（24.5±7.6）个月,统计两组患者终点事件〔短暂性脑缺血发作（TIA）、再发脑梗死、脑出血、心血管事件（急性冠脉综合征、心肌梗死）〕发生率。结果治疗前及治疗14 d后,对照组与治疗组NIHSS评分比较,差异均无统计学意义（P〉0.05）。治疗3个月后治疗组mRs评分0~1分41例（51.2%）,对照组mRs评分0~1分28例（35.0%）,两组患者mRs评分0~1分者所占比例比较,差异有统计学意义（χ2=4.306,P=0.038）。治疗前,对照组与治疗组颞窗病变侧大脑中动脉和枕窗基底动脉搏动指数（PI）比较,差异均无统计学意义（P〉0.05）;治疗14 d后,治疗组颞窗病变侧大脑中动脉和枕窗基底动脉PI较对照组降低（P〈0.05）。对照组与治疗组再发脑梗死、脑出血发生率比较,差异均无统计学意义（P〉0.05）;治疗组患者TIA、心血管事件发生率较对照组降低（P〈0.05）。治疗组患者上肢远程缺血后适应治疗过程中均未出现血压、心率、呼吸的改变,未出现其他不适感。结论上肢远程缺血后适应治疗可以改善急性脑梗死患者的神经功能及脑血管的顺应性,提高脑血流的储备能力,降低TIA及心血管事件的发生率,操作简单易行,具有较好的临床应用前景。
Objective To discuss the influences of remote ischemic post- conditioning（ RIPC） therapy of upper limb on the neurological function and prognosis of acute cerebral infarction. Methods 160 patients who were diagnosed as acute cerebral infarction from January 2013 to January 2015 in Luoyang Central Hospital Affiliated to Zhengzhou University were selected as the research objects. By random number table method,we divided these participants into two groups： the control group of 80 patients receiving routine drug therapy and formal rehabilitation training and the treatment group of 80 patients receiving routine drug therapy,formal rehabilitation training and RIPC of upper limb. National Institutes of Health Stroke Scale（ NIHSS） and TCD examination were given to the patients of the two groups before treatment and 14 days after treatment,and modified Rankin scale（ mRs） score was performed 3 months after treatment. Patients were then followed up（ 24. 5 ± 7. 6） months to measure the incidence rate of outcome events including transient ischemic attack（ TIA）,recurrent cerebral infarction,cerebral hemorrhage,cardiovascular events（ acute coronary syndrome and myocardial infarction）. Results There was no significant difference in NIHSS between the two groups before treatment and 14 days after treatment（ P〈0. 05）. 3 months after treatment,there were41（ 51. 2%） cases in the treatment group with the mRs score varying from 0 to 1, and 28（ 35. 0%） cases in the control group. There was significant difference in the ratio of patients with mRs score varying from 0 to 1 of the two groups（ χ2= 4. 306,P = 0. 038）. Before treatment,the two groups were no significantly different in pulsatility index（ PI） of the middle cerebral artery（ MCA） in the lesion side of temporal window and basilar artery（ BA） of suboccipital window（ P〈0. 05）; 14 days after treatment,PI of the MCA in the lesion side of temporal window and the BA of the suboccipital window of the treatment group lowered compared with the control group（ P〈0. 05）. There were no significant difference in the incidence rates of recurrent cerebral infarction and cerebral hemorrhage between the control group and the treatment group（ P〈0. 05）; compared with the control group,the incidence rates of TIA and cardiovascular events of patients in the treatment group lowered（ P〈0. 05）.There were no changes in patients＇ blood pressure,heart rate and respiration in the treatment group during the RIPC therapy of upper limb,and the patients did not feel any discomfortableness during the treatment of RIPC of upper limb. Conclusion RIPC of upper limb can improve the neurological function of the acute cerebral infarction patients and the cerebrovascular compliance,reserve capacity of cerebral blood flow,and reduce the occurrence rate of TIA and cardiovascular events. The operation is simple and easy,which has bright clinical application prospects.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第23期2767-2770,共4页
Chinese General Practice
