远隔缺血后适应对脑梗死患者临床疗效及脑保护作用的影响  

Influence of remote ischemic post conditioning on clinical efficacy and cerebral protective effect in patients with cerebral infarction

作　　者：陈艳洁[1] 赵紫烨[1] 朱丽霞[1] 周玉蕾[1] 白鸽[1] CHEN Yanjie;ZHAO Ziye;ZHU Lixia;ZHOU Yulei;BAI Ge(Department of Neurology,Tangshan People's Hospital,Tangshan 063000,Hebei,China)

机构地区：[1]唐山市人民医院神经内一科,河北唐山063000

出　　处：《西部医学》2024年第6期850-854,共5页Medical Journal of West China

基　　金：河北省中医药管理局科研项目(H2022564)。

摘　　要：目的探讨远隔缺血后适应(RIPC)对脑梗死患者临床疗效、脑保护作用的影响。方法选取本院2022年1月—2022年12月收治的110例脑梗死患者,采用随机数字表法分为常规组(脑梗死常规治疗)和RIPC组(常规组治疗基础上+RIPC),每组55例。比较两组疗效及两组治疗前后神经功能评分、脑血流动力学指标[搏动指数(PI)和动脉平均血流速度(Vm)]、血清炎症因子[C反应蛋白(CRP)、白介素6(IL-6)和转化生长因子-β(TGF-β)]、胱抑素C(CysC)和血清尿酸(UA)水平,记录脑缺血症状再发生及不良反应发生情况。结果治疗6个月后,RIPC组总有效率显著高于常规组(P<0.05);治疗前两组美国国立卫生研究院卒中量表(NHISS)评分和Barthel评分比较差异无统计学意义(P>0.05),治疗6个月后两组NHISS评分均较治疗前降低,Barthel评分升高(均P<0.05),且RIPC组和常规组NHISS评分和Barthel评分比较差异有统计学意义(P<0.05)。治疗前两组Vm和PI比较差异无统计学意义(P>0.05),治疗6个月后两组Vm均较治疗前升高,PI均较治疗前降低(P<0.05),且RIPC组和常规组Vm和PI比较差异有统计学意义(P<0.05)。治疗前两组IL-6、CRP和TGF-β比较差异无统计学意义(P>0.05),治疗6个月后两组IL-6、CRP均较治疗前降低,TGF-β升高(均P<0.05),且RIPC组和常规组IL-6、CRP和TGF-β比较差异有统计学意义(P<0.05)。治疗前两组CysC及UA比较差异无统计学意义(P>0.05),治疗6个月后,两组CysC及UA均较治疗前降低(P<0.05),且RIPC组和常规组比较差异有统计学意义(P<0.05);两组间脑缺血症状再发生及不良反应比较差异无统计学意义(P>0.05)。结论RIPC对脑梗死患者临床效果肯定,可发挥较好脑保护作用,有效改善患者神经功能和炎症反应,调节机体UA及CysC水平,且安全有效,值得临床推广应用。Objective To analyze the influence of remote ischemic post conditioning(RIPC)on clinical efficacy and cerebral protective effect in patients with cerebral infarction.Methods 110 patients with cerebral infarction admitted to the hospital from January 2022 to December 2022 were selected and divided into 55 cases in conventional group(conventional treatment of cerebral infarction)and 55 cases in RIPC group(RIPC based on conventional group)by the random number table method.The efficacy,and neurological function score,cerebral hemodynamic indicators[pulsatility index(PI),mean arterial blood flow velocity(Vm)],serum inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),transforming growth factor-β(TGF-β)],cystatin C(CysC)and serum uric acid(UA)before and After 6 months of treatment were compared between the two groups.The recurrence of cerebral ischemia symptoms and occurrence of adverse reactions were recorded.Results After 6 months of treatment,the total effective rate in RIPC group was significantly higher than that in conventional group(P<0.05).Before treatment,the NHISS score and Barthel score in the two groups revealed no significant differences(P>0.05).After 6 months of treatment,the NHISS score in the two groups was reduced compared with that before treatment(P<0.05)while the Barthel score was enhanced(P<0.05).There were significant differences in the NHISS score and Barthel score between RIPC group and conventional group(P<0.05).There were no significant differences in Vm and PI between the two groups before treatment(P>0.05).After 6 months of treatment,the Vm in both groups was increased compared to before treatment(P<0.05)while the PI was decreased compared with that before treatment(P<0.05),and there were significant differences in Vm and PI between RIPC group and conventional group(P<0.05).Before treatment,there were no significant differences in IL-6,CRP and TGF-βbetween the two groups(P>0.05).After 6 months of treatment,the IL-6 and CRP were declined compared with those before treatment(P<0

关 键 词：远隔缺血后适应 脑梗死 疗效 脑保护作用 

分 类 号：R743.33[医药卫生—神经病学与精神病学]