远隔缺血后适应对老年急性脑梗死患者预后的影响

摘要

目的 探讨远隔缺血后适应(RIPOC)对老年急性脑梗死患者的脑血流、神经功能、生活质量和预后的影响,并分析影响预后的危险因素. 方法 本研究为前瞻性研究.筛选2016年1月至2017年12月在聊城市第二人民医院住院治疗的老年急性脑梗死患者133例,按照随机数字表分为RIPOC组(66例)和对照组(67例).两组患者均给予常规药物治疗.同时,RIPOC组患者在入院后第2天开始每天上、下午各行一轮无创上肢缺血后适应,连续锻炼10d.比较两组患者的脑血流动力学、神经功能、生活质量评分及随访6个月不良脑血管事件,并分析影响预后的危险因素. 结果 133例患者中,男性67例,平均年龄(73.1±10.1)岁.两组间的基线情况、神经功能和血流动力学指标等差异无统计学意义(均P＞0.05).治疗10 d后,RIPOC组脑血流动力学、脑血管反应性和屏气指数高于对照组(均P＜0.05).同时,RIPOC组的神经功能恢复情况和日常生活能力评分优于对照组(均P＜0.05).随访6个月两组的心脑血管事件发生率相似(P＝0.11),多因素Logistic回归分析结果显示高龄(P=0.003)、高血压(P＝0.03)和高基线NIHSS评分(P =0.005)为预测不良预后的危险因素. 结论 RIPOC可改善老年急性脑梗死患者的神经功能恢复情况,促进脑血流恢复,提高生活质量,但对短期预后无显著影响.高龄、高血压和高NIHSS评分为短期不良预后的危险因素.%Objective To observe the effect of remote post-ischemic conditioning(RPIOC)on the cerebral blood flow,neural function and prognosis of patients with acute cerebral infarction and the risk factors for short-term prognosis.Methods 133 patients with acute cerebral infarction in the Second Hospital of Beijing from January 2016 to December 2017 were selected,and randomly divided into the RIPOC group(66 cases,with RPIOC)and the control group(67 cases,without RIPOC).In the first day after hospital,patients in the RIPOC group were given RIPOC,which was tightening the left aim with a tonometer bandage for 5 minutes per time and 2 times a day at an interval of 5 minutes.All patients were provided routine treatment.All patients' cerebral blood flow,neural function and survival data were recorded.Recovery was assessed by modified Rankin Scale(mRS)180 d after stroke.Logistic regression was used to evaluate the risk factors for prognosis.Results Of the 133 patients enrolled,there were 67 males.The mean age was (73.1 ± 10.1)year.Basic clinical characteristics,neural function and cerebral blood flow were similar between groups(P＞0.05).After 10 d treatment,cerebral blood flow and neural function was significantly increased (P＜0.05)in the RIPOC group.After 180 d follow up,the RIPOC group had significantly higher rate of adverse cerebrovascular events(P＜0.05).Logistic regression analyses demonstrated that advanced age(P =0.003),hypertension(P =0.03)and high NIHSS score(P =0.005)were all risk factors for prognosis.Conclusions RIPOC can enhance the cerebral blood flow,activities of daily living,limb function and prognosis.However,it does not reduce the risk of mortality.Advanced age,hypertension and high NIHSS score are risk factors for short-term prognosis.