远隔缺血后适应对急性缺血性脑卒中患者自主神经功能及预后的影响

Effects of remote ischemic postconditioning on autonomic nerve system function and prognosis of patients with acute ischemic stroke

目的探讨远隔缺血后适应(RIPostC)对急性缺血性脑卒中患者神经功能和预后的影响。方法选取2018年2月至2019年8月于赤峰市医院住院的104例首发且病程≤2周的缺血性脑卒中患者为观察对象。采用随机数字表法分为观察组和对照组,每组52例。两组患者均行常规治疗,观察组在此基础上采用RIPostC治疗,对照组采用安慰剂治疗,即假RIPostC治疗。比较两组患者的心率变异性[包含全部窦性心搏RR间期的标准差(SDNN)、心率变异性指数(HRVI)、相邻NN之差>50 ms的个数占总窦性新搏个数的百分比(PNN50)及全部相邻RR间期差值得均方根(rMSSD)]及美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)、Barthel指数(BI)评分情况。结果观察组患者干预后第30天的SDNN、HRVI、PNN50及rMSSD指标与对照组相比,差异有统计学意义(P<0.05);观察组患者治疗后NIHSS评分、mRS评分和BI评分与对照组比较差异有统计学意义(P<0.05);两组患者治疗期间无不良事件发生,随访90 d,无复发卒中和死亡病例。结论RIPostC治疗可改善急性缺血性脑卒中患者的肢体残障功能,改善患者预后。

Objective To investigate the effects of remote ischemic postconditioning(RIPostC)on neurological function and prognoses of patients with acute ischemic stroke.Methods A total of 104 patients with first ischemic stroke who were hospitalized from February 2018 to August 2019 in Chifeng Hospital and whose course was≤2 weeks were selected as observation objects.All the patients were divided into observation group and control group by random number table method,with 52 cases in each group.Both groups were treated conventionally.Based on this,the observation group was treated by RIPostC.The control group was treated with placebo.After treatment,the heart rate variability(HRV),including standard diviation of mormal-to-normal(SDNN),heart rate variability triangular index(HRVI),successive normal-to-normal beat interval differences exceeding 50 ms(PNN50),root mean square of the successive differences(rMSSD),American National Institute of Health stroke scale(NIHSS)score,modified Rankin Scale(mRS)score,and Barthel index(BI)score were compared between the two groups.Results The SDNN,HRVI,PNN50,and rMSSD indexes of patients in the observation group were significantly different from those in the control group at the 30th day after the intervention(P<0.05).After treatment,the NIHSS,mRS,and BI scores in the observation group were significantly different from those in the control group(P<0.05).During treatment,there was no adverse events occurred in neither group,and no recurrent stroke or death occurred during the 90-day follow-up.Conclusions RIPostC treatment can improve limb disability and improve prognoses of patients with acute ischemic stroke.