无创性肢体缺血预适应对后继脑梗死影响的临床研究

目的观察无创性肢体缺血预适应（NDLIP）对后继急性期脑梗死的影响。方法首先在老年人群中宣传肢体缺血预适应的益处,动员每人用弹性绷带绑紧大腿根部,造成下肢短时间缺血。早、中、晚各3次,5min/次,间隔10min,建立健康档案,长期跟踪观察。发现有脑梗死症状者,立即住院行脑CT检查,确诊为脑梗死后,随机归为NDLIP组,共30例。并随机选取30例未用此方法的急性脑梗死病人作为对照组。对所有病例入院时即给予脑CT检查、NIHSS评分、Barthel指数（BI）评分和Fugl-Meyer（FMA）总分评定。结果 NDLIP组脑梗死体积（3.54±2.17）cm3,对照组脑梗死体积（4.64±2.18）cm3,两组差异有统计学意义（P〈0.05）;NDLIP组NIHSS评分（12.48±3.11）,对照组NIHSS评分（20.46±2.76）,两组差异有统计学意义（P〈0.05）;NDLIP组BI指数评分（67.1±3.863）,对照组BI指数评分（39.8±2.864）,两组差异有统计学意义（P〈0.05）;NDLIP组FMA总分（35.28±5.47）,对照组FMA总分（20.76±9.22）,两组差异有统计学意义（P〈0.05）。结论 NDLIP可缩小梗死体积,减轻临床神经功能缺损程度,提高脑梗死病人日常生活活动能力和肢体运动功能,具有很好的神经保护作用,有望为脑梗死的防治提供可行的、简便的、有效的非创伤性预适应保护。

Clinical study on the influence of noninvasive delayed limb ischemic preconditioning on subsequent cerebral infarction

Objective To observe the curative effect of noninvasive delayed limb ischemic preconditioning(NDLIP)on the patients with subsequent acute cerebral infarction.Methods 60 cases of patients with subsequent acute cerebral infarction were selected for this study,the patients were divided into two groups:NDLIP group,control group.Patients in NDLIP group were preconditioned before ischemia by occluding the lower limb arteries for 5 minutes 3 times respectively in the morning,afternoon and evening at an interval of 10 minutes for a long time.All patients when found the occurrence of cerebral infarction were hospitalized to be examined by CT,and after the diagnosis of cerebral infarction,30 patients were classified into the NDLIP group.Another randomly selected 30 patients with cerebral infarction but without precondition were classified into the control group.When admitted to the hospital,all 60 patients were examined by CT and assessed with the National Institutes of Health Stroke Scale(NIHSS),the Barthel Index(BI) and the Fugl-Meyer motor function scale(FMA).Results The infraction volume was(3.54±2.17)cm3 in the NDLIP group,while(4.64±2.18)cm3 in the control group,and the difference was of statistic significance(P<0.05);the NIHSS score was(12.48±3.11)in the NDLIP group,while(20.46±2.76) in the control group,and the difference was of statistic significance(P<0.05);the BI score was(67.1±3.863)in the NDLIP group,while(39.8±2.864) in the control group,and the difference was of statistic significance(P<0.05);the FMA score was(35.28±5.47)in the NDLIP group,while(20.76±9.22)in the control group,and the difference was of statistic significance(P<0.05).Conclusion NDLIP can decrease neurological deficits and reduce the volume of infarction,enhance the activities of daily living and limb motor function,and can exert great neuroprotective effect.The discovery of the great neuroprotective potential of NDLIP has opened a feasible,simple and effective route for noninvasive preconditioning protection.