作者：赵婷，李猛，闫秋月

单位：

061000河北省沧州市中心医院神经内科

Units：

Department of Neurology, Cangzhou Central Hospital, Cangzhou 061000, China

关键词：

　脑梗死；远隔缺血适应；治疗结果

Keywords：

Brain infarction; Remote ischemic conditioning; Treatment outcome

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2023.00.211

Funds：

河北省2020年度医学科学研究课题计划项目（20200337）

摘要：

目的　分析远隔缺血适应（RIC）治疗急性脑梗死的效果。方法　选取2020年1月至2022年1月沧州市中心医院收治的急性脑梗死患者116例为研究对象。根据治疗方式，将患者分为对照组57例与RIC组59例。对照组患者进行常规治疗，RIC组患者进行常规治疗联合RIC治疗，两组患者均连续治疗14 d。比较两组临床疗效，治疗前及治疗后14 d美国国立卫生研究院卒中量表（NIHSS）、Barthel指数（BI）评分、血管内皮功能指标〔包括血管内皮生长因子（VEGF）、基质细胞衍生因子1α（SDF-1α）、可溶性细胞间黏附分子1（sICAM-1）〕、炎症因子〔C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白介素6（IL-6）〕水平，治疗期间不良反应发生率，治疗后90 d改良Rankin量表（mRS）评分、脑梗死复发率。结果　RIC组临床疗效优于对照组（P＜0.05）。RIC组治疗后14 d NIHSS评分低于对照组，BI评分高于对照组（P＜0.05）；对照组、RIC组治疗后14 d NIHSS评分分别低于本组治疗前，BI评分分别高于本组治疗前（P＜0.05）。RIC组治疗后14 d VEGF、SDF-1α水平高于对照组，sICAM-1水平低于对照组（P＜0.05）；对照组、RIC组治疗后14 d VEGF、SDF-1α水平分别高于本组治疗前，sICAM-1水平分别低于本组治疗前（P＜0.05）。RIC组治疗后14 d CRP、TNF-α、IL-6水平低于对照组（P＜0.05）；对照组、RIC组治疗后14 dCRP、TNF-α、IL-6水平分别低于本组治疗前（P＜0.05）。两组治疗期间不良反应发生率比较，差异无统计学意义（P＞0.05）。RIC组治疗后90 d mRS评分高于对照组，脑梗死复发率低于对照组（P＜0.05）。结论　RIC可有效提升急性脑梗死患者的临床疗效，减轻患者神经功能受损程度，提高生活活动能力，改善血管内皮功能，减轻炎症反应，且安全性较好；此外，RIC还可有效改善急性脑梗死患者短期预后，降低脑梗死复发率。

Abstract：

Objective To analyze the effect of remote ischemic conditioning (RIC) in the treatment of acute cerebralinfarction. Methods A total of 116 patients with acute cerebral infarction treated in Cangzhou Central Hospital from January2020 to January 2022 were selected as the study objects. According to the treatment method, the patients were divided into controlgroup of 57 cases and RIC group of 59 cases. Patients in control group received conventional treatment, patients in RIC groupreceived conventional treatment combined with RIC treatment, and all patients received continuous treatment for 14 days. Theclinical efficacy, National Institutes of Health Stroke Scale (NIHSS) , Barthel Index (BI) scores, vascular endothelial functionindexes [including vascular endothelial growth factor (VEGF) , stromal cellderived factor-1α (SDF-1α) , soluble intercellularadhesion molecule 1 (sICAM-1) ] and inflammatory factors [C-reactive protein (CRP) , tumor necrosis factor α (TNF-α) ,interleukin-6 (IL-6) ] levels before treatment and at 14 days after treatment, incidence of adverse reactions during the treatment,the modified Rankin Scale (mRS) score and recurrence rate of cerebral infarction at 90 days after treatment were comparedbetween the two groups. Results The clinical effect of RIC group was better than that of control group (P < 0.05) . The NIHSSscore at 14 days after treatment in RIC group was lower than that in control group, and the BI score was higher than that in controlgroup (P < 0.05) ; the NIHSS score at 14 days after treatment in the control group and RIC group was lower than that beforetreatment, and the BI score was higher than that before treatment, respectively (P < 0.05) . The levels of VEGF and SDF-1α at14 days after treatment in RIC group were higher than those in control group, and the levels of sICAM-1 were lower than those incontrol group (P < 0.05) ; the levels of VEGF and SDF-1α at 14 days after treatment in control group and RIC group were higher than those before treatment, and the levels of sICAM-1 were lower than those before treatment, respectively (P < 0.05) . The levelsof CRP, TNF-α and IL-6 at 14 days after treatment in RIC group were lower than those in control group (P < 0.05) ; the levelsof CRP, TNF-α and IL-6 at 14 days after treatment in control group and RIC group were lower than those before treatment,respectively (P < 0.05) . There was no significant difference in the incidence of adverse reactions during the treatment betweenthe two groups (P > 0.05) . The mRS score and recurrence rate of cerebral infarction at 90 days after treatment in RIC group werelower than those in control group (P < 0.05) . Conclusion RIC can effectively improve the clinical efficacy of patients with acutecerebral infarction, reduce the degree of neurological impairment, improve the ability of living activities and vascular endothelialfunction, reduce inflammation, and has good safety. In addition, RIC can effectively improve the short-term prognosis of acutecerebral infarction patients and reduce the recurrence rate of cerebral infarction.

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