远隔缺血后适应在急性脑梗死早期血管内治疗中的脑缺血保护作用

Protective effect of remote ischemic postconditioning on cerebral ischemia during early endovascular treatment in patients with acute cerebral infarction

目的探讨远隔缺血后适应(RIPC)对急性脑梗死患者早期血管内治疗的脑缺血保护作用。方法30例急性脑梗死患者分为RIPC组(15例)和对照组(15例)。对照组给予早期常规血管内治疗,包括溶栓、补救性动脉溶栓、取栓支架或与药物溶栓联用以实现闭塞血管再通。RIPC组在血管内治疗术前于左下肢绑缚无创血压袖带,术中第一次球囊扩张或血栓抽吸而恢复血流后1 min内开始充气加压阻断左下肢血流,充气5 min,放气5 min,交替3个循环。比较2组神经功能评分(Barthel评分及NIHSS评分)、治疗前后凝血功能(D-二聚体、纤维蛋白原)以及炎症因子IL-6、CRP水平变化。结果2组治疗后Barthel评分提高,NIHSS评分均下降,且RIPC组优于对照组,差异均有统计学意义(P均<0.05)。2组D-二聚体水平在术后24 h和术后7 d比较差异均有统计学意义(P均<0.05),纤维蛋白原、IL-6、CRP水平在术后24 h比较差异均无统计学意义(P均>0.05),而RICP组术后7 d上述水平均低于对照组(P均<0.05)。结论RIPC治疗有助于改善急性脑梗死患者神经功能症状,减轻缺血再灌注损伤,其机制可能与改善血液高凝状态,抑制炎症反应等因素有关,可能是潜在的急性脑梗死治疗方法之一。

Objective To investigate the protective effect of remote ischemic postconditioning(RIPC)on the cerebral ischemia in patients with acute cerebral infarction who underwent early endovascular treatment.Methods Thirty acute cerebral infarction patients were assigned into the RIPC(n=15)and control groups(n=15).In the control group,conventional early endovascular treatment including thrombolysis,rescue arterial thrombolysis,thrombosis stent and drug thrombolysis was performed.In the RIPC group,the protocol was started within 1 min after reflow by thrombus aspiration or balloon inflation and consisted of 3 cycles of 5 min/5 min ischemia/reperfusion by cuff inflation/deflation of the lower left limb.The NIHSS score,Barthel score,coagulation function(D-dimer and fibrinogen),inflammatory factor(IL-6,CRP)were statistically compared between two groups.Results At different time points after treatment,the Barthel scores were significantly increased,whereas the NIHSS scores were remarkably decreased in two groups(all P<0.05).The NIHSS and Barthel scores in the RIPC group were significantly better than those in the control group(both P<0.05).The D-dimer levels at postoperative 24 h and 7 d significantly differed between two groups(both P<0.05).The plasma levels of fibrinogen,IL-6 and CRP at postoperative 24 h did not significantly differ between two groups(all P>0.05).In the RICP group,the levels of fibrinogen,IL-6 and CRP at postoperative 7 d were significantly lower than those in the control group(all P<0.05).Conclusions In acute cerebral infarction patients undergoing early endovascular treatment,RIPC can improve the Barthel score,reduce the NIHSS score and attenuate ischemia-reperfusion injury probably by mitigating blood hypercoagulation and inhibiting inflammatory response.It may be a potential treatment of acute cerebral infarction.