肢体缺血后处理改善脑梗死预后和认知障碍

Remote ischemic post-conditioning: improvement outcome and cognitive impairment after stroke

目的观察肢体缺血后处理(RIPostC)对急性脑梗死神经功能的治疗作用及其对认知障碍的影响,且探讨适宜的疗程.方法收录发病72h以内、未溶栓的急性前循环梗死患者,随机分为4组,即RIPostC 10d组、RIPostC 14d组和对照10d组、对照14d组,并分别进行4个循环的充气和放气.比较美国国立卫生研究院卒中量表(NIHSS)评分、脑梗死体积(入院时、10d时、14d时和90d时),改良Rankin量表(mRS)评分(入院时、90d时良好转归率),简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)(14d时、90d时认知障碍率).结果纳入89例符合标准的急性脑梗死患者(44例RIPostC组,45例对照组),在RIPostC 10d组中仅有1例不能耐受而放弃治疗,对照组完全耐受.在对照组中,3名患者复发脑梗死(分别为30 d时、65d时和78d时),而在RIPostC各亚组中均没有发生任何相关的心脑血管事件.在90d时,与对照10d组和对照14d组相比,RIPostC 10d组和RIPostC 14d组的NIHSS评分均显著性降低(P<0.05);梗死体积分别减少33.7%和37.2%,差异有统计学意义(P<0.05);mRS的良好转归率明显增高(P<0.05);MoCA、MMSE认知障碍率显著性降低(P<0.05).与RIPostC 10d组相比,RIPostC 14d组中NIHSS评分、mRS的良好转归率无明显变化,差异无统计学意义(P>0.05).结论急性脑梗死后进行RIPostC具有很好的耐受性、安全性及可行性,能减少脑梗死体积,减少残疾,改善预后.同时,也能够改善脑梗死后认知功能障碍.但RIPostC 10d和14d对脑梗死神经功能的治疗作用及其对认知障碍的影响无显著差别,所以,RIPostC治疗10d是较为合适的治疗疗程.

Objective To investigate the therapeutic effect of limb ischemic post-conditioning(RIPostC)on acute cerebral infarction and its impact on cognitive function after cerebral infarction,and to explore the appropriate treatment regimen.Methods Non-thrombolysis patients with acute anterior circulation infarction were recruited within 72 hours after onset and randomly divided into four groups,namely RIPostC lOd group,RIPostC 14d group,lOd control group,and 14d control group.Four cycles of inflation and deflation were performed in each group.National Institute of Health Stroke Scale(NIHSS)score,cerebral infarct volume(on admission and at 10 days,14 days,and 90 days),modified Rankin Scale(mRS)score(admission score,and rate of good prognosis at 90 days),Mini-mental State Examination(MMSE)score,and Montreal Cognitive Assessment Scale(MoCA)score(cognitive impairment rates at 14 days and 90 days)were compared.Results Eighty-nine eligible patients with acute cerebral infarction(44 cases in the RIPostC group and 45 cases in the control group)were enrolled.In the RIPostC lOd group,only one patient could not tolerate and gave up treatment,while the control group was completely tolerant.In the control group,3 patients had recurrent cerebral infarction at 30 days,65 days,and 78 days,respectively,but no related cardiovascular and cerebrovascular events occurred in each RIPostC group.At 90 days,the RIPostC lOd and 14d groups had significant decreases in the NIHSS score(P<0.05)and significant reductions in the infarct volume(33.7%and 37.2%,P<0.05)compared with the lOd and 14d control groups.In addition,these two groups also had significant increases in the good prognosis rate of mRS(P<0.05)and significant decreases in the rates of MMSE and MoCA cognitive impairment.There were no significant differences in the NIHSS score and the good prognosis rate of mRS between the RIPostC 14d group and the RIPostC lOd group(P>0.05).Conclusions RIPostC is well tolerated,safe,and feasible after acute cerebral infarction,which can reduce the cerebral infarct volume and disability,and also improve prognosis.Meanwhile,it can alleviate cognitive impairment after cerebral infarction.However,RIPostC 10 days and 14 days are not significantly different regarding the treatment of cerebral infarction and their impact on cognitive function.Therefore,RIPostC 10 days is the appropriate treatment regimen for this study.