渐进式远隔缺血后适应对老年急性脑梗死患者预后影响的分析

Effect of graduall remote ischemic postconditioning on the prognosis of elderly patients with acute cerebral infarction

目的:探讨渐进式远隔缺血后适应(RIPOC)相较常规RIPOC对老年急性脑梗死患者的脑血流、神经功能、生活质量和预后的影响,并对影响预后的主要危险因素进行分析。方法:选取2018年6月至2020年8月在南京医科大学附属江宁医院住院治疗的老年急性脑梗死患者120例,按照随机数字表法分为渐进式RIPOC组(40例)、常规RIPOC组(40例)和对照组(40例)。3组患者均给予常规药物治疗。常规RIPOC组患者在入院后第2天开始每天上、下午各行1轮无创上肢缺血后适应,仪器自动充气加压至200 mmHg(1 mmHg=0.133 kPa)并维持5 min,袖带放气并维持5 min,重复5轮,共50 min,连续锻炼10 d。渐进式RIPOC组也于入院第2天开始进行仪器自动充气,加压至200 mmHg初次维持5 min,袖带放气并维持5 min,第2次充气加压维持4 min,放气4 min,依次3 min/3 min、2 min/2 min和1 min/1 min,总计5个循环,共30 min。比较3组患者的脑血流动力学、神经功能、生活质量评分及随访6个月不良脑血管事件,并分析主要危险因素。结果:3组间的基线情况(高血压、糖尿病等基础疾病,脑梗死类型)、血流动力学指标及就诊时间等差异无统计学意义(均P>0.05)。治疗10 d后,RIPOC组脑血流动力学指标、脑血管反应性和屏气指数均高于对照组(均P<0.05),渐进式RIPOC组优于常规RIPOC组。同时,RIPOC组的神经功能恢复情况和日常生活能力评分均优于对照组(均P<0.05),渐进式RIPOC组效果更佳。随访6个月3组的心脑血管事件发生率相似(P>0.05),多因素Logistic回归分析结果显示高龄(P=0.03)、高血压(P=0.03)、高NIHSS评分(P=0.006)和高胆固醇(P=0.04)为不良预后的危险因素。结论:RIPOC可改善老年急性脑梗死患者的神经功能恢复情况,促进脑血流恢复,提高生活质量,渐进式RIPOC疗法治疗时间上较常规RIPOC缩短,为患者带来便捷的同时治疗效果更优。

Objective:To investigate the effect of gradual remote ischemic postconditioning(RIPOC)on the cerebral blood flow,neurological function,quality of life and prognosis in elderly patients with acute cerebral infarction compared with conventional RIPOC.Methods:A total of 120 elderly patients with acute cerebral infarction who were hospitalized in Jiangning Hospital Affiliated to Nanjing Medical University from June 2018 to August 2020 were selected.According to the random number table,they were divided into the gradual RIPOC group(40 cases),the conventional RIPOC group(40 cases)and the control group(40 cases).The three groups of patients were given conventional medication.Patients in the conventional RIPOC group received a round of non-invasive upper limb ischemic adaptation in the morning and afternoon each day from the second day after admission.The instrument was automatically inflated and pressurized to 200 mmHg(1 mmHg=0.133 kPa)and maintained for 5 minutes.The cuff was deflated and maintained.5 minutes,repeated 5 rounds,a total of 50 minutes,continuous exercise for 10 days.The gradual RIPOC group also started automatic instrument inflation on the second day of admission,pressurized to 200 mmHg for the first 5 minutes,deflated and maintained the cuff for 5 minutes,maintained the second inflation for 4 minutes,and deflated for 4 minutes.3 min/3 min,2 min/2 min,1 min/1 min,a total of 5 cycles,a total of 30 min.The cerebral hemodynamics,neurological function,quality of life scores and 6-month follow-up adverse cerebrovascular events of the three groups were compared,and the major risk factors were nanlysed.Results:There were no statistically significant differences in baseline conditions(hypertension,diabetes,and other underlying diseases,types of cerebral infarction),hemodynamic indicators,and visit time among the three groups(all P>0.05).After 10 days of treatment,the cerebral hemodynamic indicators,cerebrovascular reactivity and breath-holding index of the RIPOC group were higher than those of the control group(all P<0.05),and the gradual RIPOC group was better than the conventional RIPOC group.At the same time,the scores of neurological function recovery and ability of daily living in the RIPOC group were better than those of the control group(both P<0.05),and the effect of the gradual RIPOC group was better.The incidence of cardiovascular and cerebrovascular events was similar in the three groups during the 6-month follow-up(P>0.05),and the multivariate Logistic regression analysis showed that advanced age(P=0.03),hypertension(P=0.03),high baseline NIHSS score(P=0.006)and and high cholesterol(P=0.04)were risk factors for predicting poor prognosis.Conclusion:RIPOC can improve the recovery of neurological function in elderly patients with acute cerebral infarction,promote the recovery of cerebral blood flow,and improve the quality of life.The treatment time of gradual RIPOC is shorter than that of conventional RIPOC,which brings convenience to patients,and at the same time,the treatment effect is better.