肢体远隔缺血预适应对缺血性脑血管病患者的脑保护作用

Neuroprotective effect of limb remote ischemic preconditioning on patients with ischemic cerebrovascular disease

目的探讨肢体远隔缺血预适应对缺血性脑血管病患者的脑保护作用。方法收集既往有短暂性脑缺血发作(TIA)或脑梗死病史,并经药物规范治疗,将高血压、血糖、血脂等危险因素控制在正常范围内,并经影像学证实为颅内外多发性狭窄的患者145例。按照3∶2的比例随机分为肢体远隔缺血预适应组(rIPC组)85例,对照组60例。两组均严格按照2011年美国卒中和TIA二级预防指南用药,控制危险因素。同时给予rIPC组患者肢体缺血预适应训练,采用双臂血压计将双上肢加压至180～200 mm Hg,维持5 min,放气休息5 min,为1个循环,每次连续训练5个循环,1次/d,共治疗6个月。观察患者神经功能改善的情况及再梗死的发生率。其中rIPC组35例,对照组26例,接受单光子发射计算机断层显像术(SPECT)检查,观察脑血流及代谢改善的情况。结果①与治疗前比较,治疗后rIPC组中神经功能缺损有改善的有71例(83.5%),对照组有40例(66.7%),差异有统计学意义,P<0.05。②MRI检查显示,rIPC组有3例(3.5%)再次发生脑梗死,对照组有8例(13.3%)再次发生脑梗死,差异有统计学意义,P<0.05。③SPECT检查显示,rIPC组脑代谢及血流较治疗前有改善的有29例(82.9%),对照组有13例(50.0%),两组差异有统计学意义,P<0.01。④rIPC后,无一例患者出现心率、血压改变及其他不适感。结论肢体远隔缺血预适应可以明显改善缺血性卒中导致的神经功能损伤、改善脑血流及代谢,并且可以预防脑梗死的再发生。

Objective To investigate the neuroprotective effect of limb remote ischemic precondition-ing （rIPC） on patients with ischemic cerebrovascular disease. Methods A total of 145 patients with previ-ous history of transient ischemie attack （TIA） or cerebral infarction treated regularly by drugs and all the risk factors controlled within the normal range were enrolled. They were diagnosed as multiple extracranial or in-tracranial stenosis with imaging. They were divided into a limb rIPC group （ n = 85 ） and a control group （n = 60） according to the ratio of 3/2. Both groups were in strict accordance with the medication of U. S. Stroke and transient ischemic attack secondary prevention guidelines 2011 and controlled the risk factors. At the same time, the rlPC group was given limb ischemic preconditioning training, using a dual-ann sphygmo- manometer to pressurize both upper limbs to 180-200 mm Hg, maintained for 5 minutes, and deflated and rested for 5 minutes as a cycle. The continuous training was 5 cycles each time, once a day for 6 months. The neurological improvement and re-infarction rate of patients were observed. Thirty-five patients in the rIPC group and 26 in the control group received single photon emission computed tomography （SPECT） examina-tion. The improvement of cerebral blood flow and metabolism was observed. Results ①Compared to the condition before treatment, the neurological deficits were improved in 71 patients （83. 5% ） in the rIPC group and 40 in the control group ＇after treatment. There was significant difference （P 〈 0. 05 ）. ②MRI examination showed that 3 patients （3.5%） in the rIPC group and 8 （ 13.3% ） in the control group had recurrent cere-bral infarction. There was significant difference （ P 〈 0.05 ） . ③Compared to the eoadition before treatment, the SPECT examination showed that cerebral metabolism and cerebral blood flow were improved in 29 patients （82. 9% ） in the rIPC group and 13 （50. 0% ） in the control group. There was significant difference between the 2 groups （P 〈0. 01 ）. ④After rlPC, no patients had heart rate, blood pressure changes, and other discom-forts. Conclusion Limb ischemia preconditioning may obviously improve neurological deficits caused by is-chemic stroke, improve the cerebral blood flow and metabolism, and prevent the recurrence of cerebral infarc- tion.