远隔肢体缺血后适应对急性脑梗死患者短期预后的效果及临床分型的影响
发布时间：2018-12-10 14:31
【摘要】：目的1探讨远隔肢体缺血后适应(LIPost C)对急性脑梗死患者短期预后的效果及对肌酶水平的影响。2分析研究远隔肢体缺血后适应(LIPost C)在脑梗死TOAST分型、OCSP分型、MRI分型、CISS分型中对不同亚型脑梗死短期预后的影响,选择最佳适应证。方法实验分两个部分:1收集2014年4月份至2015年4月份就诊于华北理工大学附属医院神经内科二病区、神经内科四病区及神经重症急性脑梗死患者220例,发病均在三天以内(不合并急性心梗),其中男性153例,年龄62.50±11.50岁,女性67例,年龄66.52±9.72岁。对照组给予常规治疗,实验组在常规治疗基础上加用远隔肢体缺血后适应(LIPost C)干预。比较2组治疗7天时的NIHSS评分和ADL评分,比较两组7天时血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和尿酸(UA)水平的变化。2连续收集2014年4月至2016年11月进行远隔肢体缺血后适应患者545例,其中男性378例,年龄63.78±11.47岁,女性167例,年龄63.74±10.47岁,比较远隔肢体缺血后适应(LIPost C)对急性脑梗死TOAST分型、OCSP分型、MRI分型、CISS分型中不同亚型脑梗死短期预后的影响。结果第一部分实验结果1实验组7天时NIHSS评分为2.09±1.98,低于对照组2.75±2.66,2组比较差异有统计学意义(P0.05);实验组7天时ADL评分为91.73±12.73,高于对照组86.86±21.19。2实验组治疗7d时血清CK、CK-MB分别是79.13±33.38 U/L、10.77±3.68 U/L,对照组分别是97.69±55.18 U/L、11.92±4.06U/L,分别低于对照组,差异有统计学意义(P0.05)。7d时尿酸水平2组比较差异无统计学意义(P0.05)。第二部分实验结果1在TOAST分型和CISS分型中,LIPost C在各亚型间的显效率无明显差别。2在OCSP分型中,LIPost C在TACI、PACI亚型与其他亚型比较,临床治疗效果好(P0.01)。3在MRI分型中,LIPost C在大梗死型组临床效果较小梗死型组预后好。结论1远隔缺血后适应干预能改善急性脑梗死患者的神经功能缺损程度,是一种安全的干预方式。2远隔肢体缺血后适应在脑梗死TOAST分型和CISS分型中,对不同亚型脑梗死短期预后的影响类似。但在脑梗死OCSP分型和MRI分型中,对不同亚型脑梗死短期预后产生不同的影响,前循环闭塞型效果较好,大面积梗塞型优于小面积梗塞型。提示LIPost C应在适宜的、有选择的脑梗死亚型中应用。
[Abstract]:Objective 1 to investigate the effect of adaptation to (LIPost C) after distal limb ischemia on the short-term prognosis of patients with acute cerebral infarction and the effect of adaptation to (LIPost C) on the level of myoenzyme in patients with acute cerebral infarction (ACI), and to study the role of adaptive (LIPost C) in the classification of TOAST, OCSP and MRI in patients with cerebral infarction after distal limb ischemia. The effect of CISS classification on the short-term prognosis of different subtypes of cerebral infarction was evaluated and the best indication was selected. Methods the experiment was divided into two parts: (1) 220 patients with severe acute cerebral infarction were collected from April 2014 to April 2015 in Department of Neurology, affiliated Hospital of North China University of Science and Technology. The incidence was within three days (no acute myocardial infarction), including 153 males (62.50 卤11.50 years old) and 67 females (66.52 卤9.72 years old). The control group was given routine treatment, and the experimental group was treated with (LIPost C) on the basis of routine treatment. The NIHSS score and ADL score at 7 days after treatment were compared between the two groups, and the serum creatine kinase (CK), was compared between the two groups on the 7th day after treatment. Changes of creatine kinase isoenzyme (CK-MB) and uric acid (UA). 2 545 cases of adaptation to distant limb ischemia from April 2014 to November 2016 were collected, including 378 males aged 63.78 卤11.47 years and 167 females. The age of 63.74 卤10.47 years, compared with the influence of adaptation to (LIPost C) after distal limb ischemia on the short-term prognosis of different subtypes of cerebral infarction in acute cerebral infarction (TOAST), OCSP classification, MRI classification and CISS classification. Results in the first part of the experiment, the NIHSS score of the experimental group was 2.09 卤1.98 on the 7th day, which was lower than that of the control group (2.75 卤2.66) (P0.05). The ADL score of the experimental group was 91.73 卤12.73 on the 7th day, which was higher than that of the control group (86.86 卤21.19.2). The serum CK,CK-MB of the experimental group was 79.13 卤33.38 U / L 10.77 卤3.68 U / L, respectively. The control group was 97.69 卤55.18 UL / L 11.92 卤4.06U / L, respectively, which was lower than the control group, the difference was statistically significant (P0.05). There was no significant difference in uric acid level between the two groups at 7 days (P0.05). In the second part, there was no significant difference in the significant efficiency of, LIPost C between subtypes in TOAST typing and CISS typing. 2, LIPost C in TACI,PACI subtype was compared with other subtypes in OCSP typing. 3 in MRI classification, LIPost C had better prognosis in large infarction group than in small infarction group. Conclusion (1) adaptation intervention after distant ischemia can improve the degree of neurological deficit in patients with acute cerebral infarction, and is a safe intervention mode. (2) adaptation after distal limb ischemia can be used in TOAST classification and CISS classification of cerebral infarction. The effects on the short-term prognosis of different subtypes of cerebral infarction were similar. However, in the OCSP classification and MRI classification of cerebral infarction, the short-term prognosis of different subtypes of cerebral infarction was different. The effect of anterior circulation occlusion type was better, and the large area infarction type was superior to the small area infarction type. The results suggest that LIPost C should be used in suitable and selective subtypes of cerebral infarction.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2370744
[Abstract]:Objective 1 to investigate the effect of adaptation to (LIPost C) after distal limb ischemia on the short-term prognosis of patients with acute cerebral infarction and the effect of adaptation to (LIPost C) on the level of myoenzyme in patients with acute cerebral infarction (ACI), and to study the role of adaptive (LIPost C) in the classification of TOAST, OCSP and MRI in patients with cerebral infarction after distal limb ischemia. The effect of CISS classification on the short-term prognosis of different subtypes of cerebral infarction was evaluated and the best indication was selected. Methods the experiment was divided into two parts: (1) 220 patients with severe acute cerebral infarction were collected from April 2014 to April 2015 in Department of Neurology, affiliated Hospital of North China University of Science and Technology. The incidence was within three days (no acute myocardial infarction), including 153 males (62.50 卤11.50 years old) and 67 females (66.52 卤9.72 years old). The control group was given routine treatment, and the experimental group was treated with (LIPost C) on the basis of routine treatment. The NIHSS score and ADL score at 7 days after treatment were compared between the two groups, and the serum creatine kinase (CK), was compared between the two groups on the 7th day after treatment. Changes of creatine kinase isoenzyme (CK-MB) and uric acid (UA). 2 545 cases of adaptation to distant limb ischemia from April 2014 to November 2016 were collected, including 378 males aged 63.78 卤11.47 years and 167 females. The age of 63.74 卤10.47 years, compared with the influence of adaptation to (LIPost C) after distal limb ischemia on the short-term prognosis of different subtypes of cerebral infarction in acute cerebral infarction (TOAST), OCSP classification, MRI classification and CISS classification. Results in the first part of the experiment, the NIHSS score of the experimental group was 2.09 卤1.98 on the 7th day, which was lower than that of the control group (2.75 卤2.66) (P0.05). The ADL score of the experimental group was 91.73 卤12.73 on the 7th day, which was higher than that of the control group (86.86 卤21.19.2). The serum CK,CK-MB of the experimental group was 79.13 卤33.38 U / L 10.77 卤3.68 U / L, respectively. The control group was 97.69 卤55.18 UL / L 11.92 卤4.06U / L, respectively, which was lower than the control group, the difference was statistically significant (P0.05). There was no significant difference in uric acid level between the two groups at 7 days (P0.05). In the second part, there was no significant difference in the significant efficiency of, LIPost C between subtypes in TOAST typing and CISS typing. 2, LIPost C in TACI,PACI subtype was compared with other subtypes in OCSP typing. 3 in MRI classification, LIPost C had better prognosis in large infarction group than in small infarction group. Conclusion (1) adaptation intervention after distant ischemia can improve the degree of neurological deficit in patients with acute cerebral infarction, and is a safe intervention mode. (2) adaptation after distal limb ischemia can be used in TOAST classification and CISS classification of cerebral infarction. The effects on the short-term prognosis of different subtypes of cerebral infarction were similar. However, in the OCSP classification and MRI classification of cerebral infarction, the short-term prognosis of different subtypes of cerebral infarction was different. The effect of anterior circulation occlusion type was better, and the large area infarction type was superior to the small area infarction type. The results suggest that LIPost C should be used in suitable and selective subtypes of cerebral infarction.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
【参考文献】
相关期刊论文 前10条
1 何洁;吉训明;;颅内动脉狭窄患者行远隔缺血后适应治疗的单光子发射计算机断层摄影评价研究[J];中华老年心脑血管病杂志;2016年10期
2 常莉莎;张云鹤;彭延波;张江;王大力;;无创性远隔肢体缺血后适应对大鼠急性脑缺血的影响[J];中国实验诊断学;2016年05期
3 张江;常莉莎;梁鹏;刘会英;王大力;;反复无创性肢体缺血后适应对大鼠脑缺血的保护作用[J];中华老年心脑血管病杂志;2015年11期
4 张江;常莉莎;王大力;周涛;刘会英;;远程缺血后适应中大鼠海马CA1区TLR4和IL-6的表达变化及其意义[J];中国免疫学杂志;2015年08期
5 石秋艳;陈历;刘爱东;张春阳;孙原;孙尚帛;;观察远隔肢体缺血对大鼠急性脑梗死再灌注损伤的保护效应及其机制的探讨[J];现代预防医学;2015年11期
6 董林菲;王峥;陈伟贤;钱云;;急性脑梗死患者血清尿酸、超敏C反应蛋白的改变及其临床意义[J];临床神经病学杂志;2015年01期
7 李馨蕊;任长虹;吉训明;韩剑虹;;远隔缺血预适应脑保护的实施方式及其机制的研究进展[J];中国脑血管病杂志;2014年05期
8 吴怀国;侯庆兵;王书培;江艳柳;张璐;;远程肢体缺血后适应对脑血流的影响[J];中华脑血管病杂志(电子版);2013年06期
9 王晓明;;青浦地区急性脑梗死患者CISS分型和TOAST分型比较及意义[J];中国老年学杂志;2013年11期
10 马林林;任长虹;李宁;吉训明;曾现伟;;两种远隔缺血期适应的脑保护作用对比研究[J];中国现代神经疾病杂志;2013年04期
相关博士学位论文 前1条
1 张晓峰;蛋白激酶C在电针预处理和远程缺血后处理诱导脑保护中的作用[D];第四军医大学;2010年
相关硕士学位论文 前1条
1 张桂林;GM1对新生大鼠缺氧缺血性脑损伤细胞凋亡的作用[D];第一军医大学;2000年
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