Li Yuejuan, Liang Keke, Zhang Long, Hu Yamei, Ge Yunli, Zhao Jianhua
Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China.
Departments of Neurology, Zhengzhou University People's Hospital, Zhengzhou, China.
J Stroke Cerebrovasc Dis. 2018 Nov;27(11):3328-3335. doi: 10.1016/j.jstrokecerebrovasdis.2018.07.039. Epub 2018 Sep 7.
This study aims to observe the clinical effect of upper limb ischemic postconditioning (LIPostC) as an adjunct to treatment with acute stroke patients, possibly due to increased cerebral perfusion.
We perform a randomized blinded placebo controlled trial in nonthrombolysis patients with acute ischemic stroke, within 72hours of ictus, divided into the LIPostC group and control group. The LIPostC group is induced by 4 cycles of intermittent repeated limb ischemia: alternating 5 minutes inflation (20mm Hg above systolic blood pressure) and 5 minutes deflation performed manually using a standard upper arm blood pressure cuff in the nonparetic arm. The control group receives a sham procedure (cuff inflation to 30mm Hg). Patients underwent the intervention from the time of enrollment to Day 14. Comparison of National Institutes of Health Stroke Scale (NIHSS) score, cerebral infarction volume, relative Perfusion weighted imaging (PWI) parameters (regional relative cerebral blood flow, regional relative mean transit time; preintervention [day 0], day 14, day 90), modified Rankin Scale (mRS; the preintervention score [day 0], the curative ratio at day 90 [we define 0-1 score as close to recovery or full recovery]).
Sixty eligible patients with acute stroke (29 LIPostC and 31 control) are recruited age 65years (SD 12.22), blood pressure 156/74mm Hg (SD 14/10), and NIHSS score 5.98 (SD 3.35), mRS score 2.25 (SD .79). Only 1 in the LIPostC group is intolerant the first cycle to give up. All patients tolerate the sham procedure. Two patients experience recurrent stroke versus none in the LIPostC group. Day 90, compared with the control group, there is a significant decrease the NIHSS score, regional relative mean transit time (P < .05) and increase the curative ratio of mRS, regional relative cerebral blood flow(P < .05) in the LIPostC group, which infarct volume decreased by 31.3% (P < .05).
LIPostC after acute stroke is well tolerated and appears safe and feasible. LIPostC may improve neurological outcome, and protective mechanisms may be increased cerebral blood flow to improve cerebral perfusion. A larger trial is warranted.
本研究旨在观察上肢缺血后处理（LIPostC）作为急性中风患者治疗辅助手段的临床效果，这可能是由于脑灌注增加所致。
我们对急性缺血性中风的非溶栓患者进行了一项随机双盲安慰剂对照试验，在发病72小时内，分为LIPostC组和对照组。LIPostC组通过4个周期的间歇性重复肢体缺血诱导：使用标准上臂血压袖带在非瘫痪侧手臂手动交替进行5分钟充气（收缩压以上20mmHg）和5分钟放气。对照组接受假手术（袖带充气至30mmHg）。患者从入组时开始接受干预直至第14天。比较美国国立卫生研究院卒中量表（NIHSS）评分、脑梗死体积、相对灌注加权成像（PWI）参数（区域相对脑血流量、区域相对平均通过时间；干预前[第0天]、第14天、第90天）、改良Rankin量表（mRS；干预前评分[第0天]、第90天治愈率[我们将0 - 1分定义为接近恢复或完全恢复]）。
招募了60例符合条件的急性中风患者（29例LIPostC组和31例对照组），年龄65岁（标准差12.22），血压156/74mmHg（标准差14/10），NIHSS评分5.98（标准差3.35），mRS评分2.25（标准差0.79）。LIPostC组只有1例在第一个周期不耐受而放弃。所有患者均耐受假手术。对照组有2例发生复发性中风，而LIPostC组无。在第90天，与对照组相比，LIPostC组的NIHSS评分、区域相对平均通过时间显著降低（P < 0.05），mRS治愈率、区域相对脑血流量增加（P < 0.05），梗死体积减少31.3%（P < 0.
