肢体缺血后处理治疗急性脑梗死后认知障碍的临床随机对照研究  

Remote limb ischemic postconditioning on cognitive impairment after acute ischemic stroke:a randomized controlled clinical trial

作　　者：梁可可[1] 时雅辉 李月娟[3] 刘东清 张龙[1] 潘蕊 赵建华[1] LIANG Keke;SHI Yahui;LI Yuejuan(Department Neurology,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院神经内科,河南郑州450003 [2]广东同江医院神经内科,广东佛山528000 [3]黄河中心医院神经内科,河南郑州450003

出　　处：《中风与神经疾病杂志》2018年第9期817-822,共6页Journal of Apoplexy and Nervous Diseases

基　　金：河南省科技攻关项目(No.182102310171)

摘　　要：目的观察肢体缺血后处理治疗脑梗死后认知障碍的临床疗效。方法选取2016年6月~2017年8月在河南省人民医院神经内科住院治疗的48例急性脑梗死患者作为研究对象,采用区组随机化分组的方法将其随机纳入肢体缺血后处理组(23例)和对照组(25例),两组患者均予以常规药物治疗,在常规药物治疗的基础上对肢体缺血后处理组采用无创标准上肢血压袖带进行每天4个周期的反复充气(高于收缩压20 mm Hg)和放气,各维持5 min,对照组每天进行4个周期的假-肢体缺血后处理治疗,仅将袖带加压至30 mm Hg(此血压可刚好给予肢体一定的压力,但不造成上肢血流阻断)。持续14 d。共随访90 d,比较两组患者入院时、病程7 d和14 d时血清HSP27、HSP70变化情况,比较病程90 d时两组患者认知功能和神经功能评分,评价肢体缺血后处理治疗急性脑梗死后认知障碍的安全性。结果比较两组患者在整个治疗及随访阶段观察到的不良事件,差异无统计学意义(P> 0.05);病程7 d、病程14 d时,两组患者血清HSP27、HSP70差异有统计学意义(P <0.05)。随访90 d时,肢体缺血后处理组认知功能优于对照组,差异有统计学意义(P <0.05);肢体缺血后处理组改善急性脑梗死患者90 d时NIHSS评分,改善神经功能(P <0.05)。结论肢体缺血后处理治疗急性脑梗死后认知障碍安全、可行,具有良好的耐受性,可有效减少脑梗死后认知功能损害。Objective We aimed to evaluate the efficacy of repeated episodes of limb ischemia and reperfusion(remote limb ischemic postconditioning[RIPostC])in patients with cognitive impairment after ischemic stroke.Methods Forty-eight patients with acute ischemic stroke who were treated in the department of neurology,Henan Provincial People’s Hospital from June 2016 to August 2017 were enrolled in this study,randomized 1:1 to receive 4 cycles of RIPostC(23 patients)or sham ischemia-reperfusion cycles(25 patients)daily for 14 days,RIPostC using a standard upper arm blood pressure cuff with alternating 5 minutes inflation(20 mmHg above systolic blood pressure)and 5 minutes deflation performed manually.The control group received a sham procedure(cuff inflation to 30 mmHg).Two groups of patients were given conventional drug treatment.The primary outcome was tolerability,feasibility and safety.Secondary outcomes included plasma HSP27、HSP70,cognitive function and clinical efficacy at the end of 90-day follow-up.Results There was no significant difference in the adverse events between the two groups of patients during the whole treatment and follow-up period(P>0.05).At 7 days,14 days,there was significant difference between two groups(P<0.05).At 90 days,the cognitive function of the limb ischemic post treatment group was better than that of the control group(P<0.05).RIPostC group improved the NIHSS score of the patients with acute cerebral infarction at 90 days(P<0.05).Conclusion RIPostC seems to be safe,feasible and well tolerated in patients with cognitive impairment after acute ischemic stroke.RIPostC can slow the cognitive decline after acute ischemic stroke.

关 键 词：肢体缺血后处理 急性脑梗死 认知功能障碍 热休克蛋白27 热休克蛋白70 

分 类 号：R743[医药卫生—神经病学与精神病学]