rt-PA 联合远程缺血后处理治疗急性缺血性脑卒中。
rt-PA with remote ischemic postconditioning for acute ischemic stroke.
机构信息
Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.
Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine Xuanwu Hospital Capital Medical University Beijing China.
出版信息
Ann Clin Transl Neurol. 2019 Jan 16;6(2):364-372. doi: 10.1002/acn3.713. eCollection 2019 Feb.
OBJECTIVE
To investigate the feasibility and safety of remote ischemic postconditioning (RIPC) in acute ischemic stroke patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis (IVT).
METHODS
We performed a pilot randomized trial involving acute ischemic stroke patients with IVT. The patients were randomized 1:1 to receive RIPC or standard medical therapy. In the RIPC group, the participants underwent instant RIPC within 2 h of IVT, followed by repeated RIPC therapy for 7 days. The feasibility end point was the completion of RIPC and time from the first RIPC to finishing IVT in the RIPC group. The safety end point included tissue and neurovascular injury resulting from RIPC, changes in vital signs, level of plasma myoglobin, any hemorrhagic transformation, and other adverse events.
RESULTS
Thirty patients (15 RIPC and 15 Control) were recruited after IVT. The mean age was 65.7 ± 10.2 years, with a National Institutes of Health Stroke Scale (NIHSS) score of 6.5 (4.0-10.0). The completion rate for RIPC was 97.0%. The mean time from first RIPC to completing IVT was 66.0 (25.0-75.0) min in the RIPC group. One case of hemorrhagic transformation was observed in the RIPC group. No significant difference was found in the level of myoglobin between the two groups (>0.05).
INTERPRETATION
RIPC is effective and safe for AIS patients after intravenous rt-PA thrombolysis.
目的
探讨远程缺血后处理（RIPC）在急性缺血性脑卒中患者静脉重组组织型纤溶酶原激活剂（rt-PA）溶栓（IVT）后的可行性和安全性。
方法
我们进行了一项涉及接受 IVT 的急性缺血性脑卒中患者的试点随机试验。将患者以 1:1 的比例随机分为 RIPC 组或标准药物治疗组。在 RIPC 组中，患者在 IVT 后 2 小时内立即接受 RIPC，然后重复 RIPC 治疗 7 天。可行性终点是 RIPC 完成情况和 RIPC 组中从第一次 RIPC 到完成 IVT 的时间。安全性终点包括 RIPC 引起的组织和神经血管损伤、生命体征变化、血浆肌红蛋白水平、任何出血性转化以及其他不良事件。
结果
IVT 后共招募了 30 例患者（15 例 RIPC 和 15 例对照组）。平均年龄为 65.7±10.2 岁，国立卫生研究院卒中量表（NIHSS）评分为 6.5（4.0-10.0）。RIPC 完成率为 97.0%。RIPC 组从第一次 RIPC 到完成 IVT 的平均时间为 66.0（25.0-75.0）分钟。RIPC 组有 1 例出现出血性转化。两组肌红蛋白水平无显著差异（>0.05）。
结论
RIPC 对接受静脉 rt-PA 溶栓的急性缺血性脑卒中患者是有效且安全的。
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