远隔缺血后适应对卒中后疲劳患者的临床疗效及影响因素

Clinical efficacy and influencing factor of Remote Ischemic Postconditioning in Patients with Post Stroke Fatigue

目的研究远隔缺血后适应(remote ischemic postconditioning,RIPostC)对卒中后疲劳(post stroke fatigue,PSF)患者的临床疗效及影响因素分析。方法收集PSF患者80例,随机分为试验组(n=40)和对照组(n=40)。两组患者均接受常规康复训练、常规药物治疗,试验组在常规治疗基础上额外施加RIPostC,共4周。治疗前后采用美国国立卫生研究院卒中量表(NIHSS)评估神经功能、Barthel指数(BI)评估日常活动能力,简易智力状态检查量表(MMSE)评估认知功能、疲劳严重度量表(FSS)评估疲劳严重程度以及汉密尔顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)评估情绪。结果治疗后两组患者的NIHSS、HAMA、HAMD和FSS评分均较治疗前明显下降,而BI和MMSE评分均较治疗前升高,差异有统计学意义(|t|>7.306,P<0.01);治疗前后两组患者NIHSS、BI、MMSE、FSS、HAMA和HAMD评分差值差异均有统计学意义(|t|>8.871,P<0.01),试验组的各项评分改善更加明显;FSS的影响因素为MMSE和HAMA。结论远隔缺血后适应可显著改善卒中后疲劳患者的神经功能、日常活动能力和认知功能,缓解疲劳症状、焦虑和抑郁情绪,卒中后疲劳的影响因素为认知功能和焦虑情绪。

Objective To investigate the clinical effects and influencing factors of remote ischemic post⁃conditioning RIPostC in the patients with post stroke fatigue(PSF).Methods Eighty patients with PSF were ran⁃domly divided into experimental group(n=40)and control group(n=40).Patients in both groups received routine drug therapy and rehabilitation training for stroke.The experimental group were additionally given RIPostC for four weeks.They were evaluated with National Institute of Health Stroke Scale(NIHSS),Barthel Index(BI),Mini-mental State Examination(MMSE),fatigue severity scale(FSS),Hamilton Anxiety Scale(HAMA),and Hamilton Depression Scale(HAMD).Results The score of NIHSS,FSS,HAMA and HAMD in the both groups were decreased,while the score of BI and MMSE were increased(P<0.01).The difference in the score of NIHSS,BI,MMSE,FSS,HAMA and HAMD between the two groups before and after treatment showed statistical significance(P<0.01)and the difference in the score was more significant in the experimental group.The risk factors of FSS were MMSE and HAMA.Conclusion RIPostC can effectively improve the neurological deficits,daily activity ability and cog⁃nitive function,alleviate fatigue,anxiety and depression in the patients of PSF.The influencing factors of PSF are cognitive function and anxiety.