短暂性肢体缺血后处理治疗急性脑梗死的疗效观察

Observation on Clinical Effect of transient limb remote ischemic Postconditioning in Treating Acute Cerebral Infarction

目的探讨肢体缺血后处理治疗急性脑梗死的临床疗效。方法选择2015年3月~2016年6月在我院住院治疗的158例未进行溶栓治疗的急性脑梗死(发病72 h内)患者作为研究对象,所有患者均经影像证实,按照入院先后顺序随机分为治疗组和对照组。所有患者均给予常规治疗,治疗组在常规治疗的基础上给予4个短周期单侧上肢缺血再灌注,每天进行1次连续7 d。比较入院时和病程14 d时两组患者的临床疗效;入院时、病程14 d和病程3 m时的美国国立卫生研究院卒中量表(NIHSS)和磁共振灌注加权成像(PWI);入院时和病程3 m时的改良Rankin量表(mRS)、梗死体积。结果治疗14 d后,治疗组总有效率(95.9%)高于对照组(79.0%),差异有统计学意义(P<0.05);两组患者NIHSS评分、rMTT在入院时和病程14 d时差异无统计学意义,均在病程3 m时差异有统计学意义(P<0.05);病程3 m时,治疗组mRS较对照组下降(P<0.05),治疗组梗死体积较对照组减小(P<0.05)。结论在急性脑梗死患者常规治疗的基础上给予短暂性肢体缺血后处理治疗,可以提高患者的临床疗效,减轻NIHSS评分及mRS评分,减小梗死体积,增加脑灌注。

Objective To study on clinical effect of remote ischemic postconditioning（RIPC） in treating acute cere- bral infarction. Methods Selection of 158 consecutive patients with acute cerebral infarction within 72 hours who were ad- mitted to hospital from March 2015 to June 2016 in our hospital and randomized to intervention group and control group. All patients have been confirmed by MRI and did not receive thrombolytic therapy. All patients were given conventional treat- ment, the treatment group on the basis of conventional treatment on the basis of 4 short period of unilateral upper limb ische- mia reperfusion, a continuous 7 d. The clinical efficacy of the two groups were compared at admission and duration of 14 d; the time of admission, the course of 14 d and duration of 3 months at the National Institutes of Health Stroke Scale （NIHSS） and perfusion weighted magnetic resonance imaging（PWI） ;admission and duration 3M the modified Rankin scale（mRS） , stem dead volume. Results After 14 d treatment,the total effective rate of treatment group （95.9%）was higher than the control group（ 79% ）, the difference was statistically significant （P 〈 0.05 ） ;two patients with NIHSS score and rMTr on ad- mission and duration of 14 d showed no significant difference, both in the course of 3 months was statistically significant（ P 〈 0.05 ） ; the course of 3M when the mRS of the treatment group than the control group （P 〈 0.05 ）, the treatment group than the control group decreased the infarct volume （ P 〈 0.05 ）. Conclusion On the basis of routine treatment in patients with acute cerebral infarction with transient limb ischemic postprocessing treatment can improve the clinical curative effect of the patients, reduce the NIHSS score and mRS score, reduce infarct volume, increase cerebral perfusion.