肢体缺血预适应训练对脑梗死患者脑血流灌注及再发的影响

Effects of Limb Ischemic Preconditioning Training on Cerebral Blood Flow Perfusion and Recurrence in Patients with Cerebral Infarction

目的探讨肢体缺血预适应训练对脑梗死患者脑血流灌注及再发的影响。方法采用便利抽样法选取2021年3月至2022年3月唐山市人民医院收治的96例脑梗死患者为研究对象,根据治疗方法不同分为对照组和观察组,各48例。对照组给予基础治疗及药物治疗(硫酸氢氯吡格雷片每次75 mg、每日1次,阿司匹林每次100 mg、每日1次),共治疗1个月;观察组在对照组基础上进行肢体缺血预适应训练,共治疗1个月。于治疗前、治疗1个月后,比较两组患者脑血流灌注指标(脑血容量、脑血流量),神经功能缺损情况[美国国立卫生研究院卒中量表(NIHSS)评分]、认知功能[蒙特利尔认知评估量表(MoCA)评分],以及两组患者6个月内脑梗死再发情况。结果治疗前后脑血容量、脑血流量的主效应差异有统计学意义(P<0.01);不考虑测量时间,各指标组间的主效应差异有统计学意义(P<0.01);组间和时点间存在交互作用(P<0.01)。与治疗前相比,治疗后两组脑血容量、脑血流量均升高,且观察组高于对照组[(2.37±0.27)ml/100 g比(1.97±0.28)ml/100 g、(22.9±1.9)ml/(100 g·min)比(19.5±1.8)ml/(100 g·min)](P<0.05)。治疗前后NIHSS、MoCA评分的主效应差异有统计学意义(P<0.01);不考虑测量时间,NIHSS、MoCA评分组间的主效应差异有统计学意义(P<0.05或P<0.01);组间和时点间存在交互作用(P<0.01)。与治疗前相比,治疗后两组NIHSS评分均降低,且观察组低于对照组[(10.21±2.9)分比(14.56±3.2)分](P<0.05);治疗后两组MoCA评分均升高,且观察组高于对照组[(27.1±2.3)分比(23.9±3.6)分](P<0.05)。随访6个月后,观察组再发率低于对照组[10.42%(5/48)比27.08%(13/48)](χ^(2)=4.376,P=0.036)。结论肢体缺血预适应训练可改善脑梗死患者脑血流灌注、神经功能缺损情况及认知功能,且可预防脑梗死再发。

Objective To explore the effect of limb ischemic preconditioning training on cerebral blood flow perfusion and recurrence in patients with cerebral infarction.Methods The convenient sampling method was used to select 96 patients with cerebral infarction admitted to Tangshan People′s Hospital from Mar.2021 to Mar.2022.According to the different treatment methods,they were divided into a control group and an observation group,with 48 cases each.The control group was given basic treatment and drug treatment(clopidogrel bisulfate orally,75 mg/time,once a day;aspirin orally,100 mg/time,once a day,for a total of one month);the observation group was given limb ischemic preconditioning training on the basis of the control group′s regimen,for a total of one month.Before treatment and 1 month after treatment,the cerebral blood flow perfusion(cerebral blood volume,cerebral blood flow),the neurological deficits[National Institutes of Health stroke scale(NIHSS)score]and cognitive function[Montreal cognitive assessment(MoCA)score]were compared between the two groups.The patients in both groups were followed up for 6 months to compare the recurrence of cerebral infarction.Results The cerebral blood volume and cerebral blood flow main effects before and after treatment were statistically significant(P<0.01).Regardless of the measurement time,the main effect difference of each indicator between groups was statistically significant(P<0.01).There were interactions between groups and time points(P<0.01).Compared with before treatment,cerebral blood volume and cerebral blood flow were increased in both groups after treatment.The observation group was higher than the control group[(2.37±0.27)ml/100 g vs(1.97±0.28)ml/100 g,(22.9±1.9)ml/100(g·min)vs(19.5±1.8)ml/(100 g·min)](P<0.05).The main effect differences of NIHSS and MoCA scores before and after treatment were statistically significant(P<0.01).Regardless of measurement time,the main effects of NIHSS and MoCA between groups were statistically significant(P<0.05 or P<0.01).There were interactions between groups and time points(P<0.01).Compared with before treatment,the NIHSS score of both groups was lower after treatment,and the observation group was lower than the control group(10.21±2.9 vs 14.56±3.2)(P<0.05).After treatment,the MoCA score of both groups was increased,and the observation group was higher than the control group(27.1±2.3 vs 23.9±3.6)(P<0.05).After 6 months of follow-up,the recurrence rate of the observation group was lower than that of the control group[10.42%(5/48)vs 27.08%(13/48)](χ^(2)=4.376,P=0.036).Conclusion Limb ischemic preconditioning training can improve cerebral blood flow perfusion,neurological function defects and cognitive function in patients with cerebral infarction,and can prevent the recurrence.