肢体缺血后处理对急性脑梗死的保护作用及其机制研究

发布时间：2018-05-03 01:10

本文选题：脑梗死 + 肢体缺血后处理　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景脑梗死是世界上导致人类死亡和残疾的主要原因。理论上,溶栓理应成为脑梗死的最佳治疗方案,但结果并没有人们预期的那么好。因此要求我们必须探索出新的治疗方法,国内外的研究者把注意力转移到了内源性保护的研究上,如缺血处理。国外的许多基础和临床实验已经证实了肢体缺血后处理具有神经保护的作用。目前尚无肢体缺血后处理治疗急性脑梗死的临床报道。本研究分以下两部分探讨肢体缺血后处理对急性脑梗死的保护作用及其可能机制。第一部分肢体缺血后处理对急性脑梗死的保护作用目的探讨肢体缺血后处理治疗急性脑梗死的临床疗效方法选择2015年3月~2016年6月在河南省人民医院神经内科一病区住院治疗的经磁共振DWI序列明确诊断为急性脑梗死(发病72小时内)且未进行溶栓治疗的158例患者作为研究对象,按照患者入院的先后顺序,将患者随机分为治疗组(肢体缺血后处理组)和对照组。入组的所有患者都会给予常规治疗。治疗组在常规治疗的同时,又给予了肢体缺血后处理治疗。比较入院时、病程14天和病程3个月时的美国国立卫生研究院卒中量表(NIHSS);入院时和病程3个月时的改良Rankin量表(m RS);病程14天时两组患者的临床疗效。结果1.两组患者NIHSS评分在入院时和病程14天时差异无统计学意义(P0.05),而在病程3个月时差异有统计学意义(P0.05);2.病程3个月时,肢体缺血后处理组的m RS评分较对照组下降,差异有统计学意义(P0.05);3.病程14天时,肢体缺血后处理组治疗急性脑梗死的总有效率(95.9%)高于对照组(79.0%),差异有统计学意义(P0.05)。结论1.肢体缺血后处理可以改善急性脑梗死患者的NIHSS评分及m RS评分2.肢体缺血后处理治疗可以提高急性脑梗死患者的临床疗效第二部分肢体缺血后处理对急性脑梗死患者的脑梗死体积及脑灌注的影响目的探讨肢体缺血后处理对急性脑梗死患者的脑梗死体积及脑灌注的影响方法选择2015年3月~2016年6月在河南省人民医院神经内科一病区住院治疗并完成了整个肢体缺血后处理治疗周期并按时随访的136例急性脑梗死患者作为研究对象。由专人收集入组患者的相关资料。采用Siemens Trio Tim 3.0T超导型全身磁共振扫描仪对患者进行扫描。所有入组患者均在入院时(发病72小时内)、病程14天、病程1个月、病程3个月时完成磁共振的相关检查。比较入院时、病程14天时、病程1个月时和病程3个月时的脑梗死体积;入院时、病程14天和病程3个月时的相对PWI参数。结果1.在病程1个月和3个月时,肢体缺血后处理组的梗死体积较对照组分别减小36%和34%的梗死体积(P0.05)。2.肢体缺血后处理组和对照组患者rr CBV、rr CBF、r MTT及r TTP在入院时和病程14天时差异无统计学意义,在病程3个月时差异均有统计学意义(P0.05)。结论1.肢体缺血后处理可以减小急性脑梗死患者的脑梗死体积。2.肢体缺血后处理可以改善急性脑梗死患者的脑灌注。
[Abstract]:Background cerebral infarction is the major cause of human death and disability in the world. Thrombolytic therapy should theoretically be the best treatment for cerebral infarction, but the results are not as good as expected. Therefore, we need to explore new treatments, and researchers at home and abroad have shifted their attention to endogenous protection research. Such as ischemic treatment. Many foreign basic and clinical trials have confirmed the role of neuroprotection in limb ischemic postconditioning. There is no clinical report on the treatment of acute cerebral infarction after limb ischemia. This study is divided into two parts to discuss the protective effect of limb ischemic postconditioning on acute cerebral infarction and its possible mechanism. Part of the protective effect of ischemic postconditioning on acute cerebral infarction in order to explore the clinical efficacy of ischemic postconditioning in the treatment of acute cerebral infarction. In June ~2016 March 2015, the diagnosis of acute cerebral infarction (72 hours within the onset of acute cerebral infarction) was confirmed by the DWI sequence of magnetic resonance (MRI) in a hospital in the Department of Neurology, Henan Province People's Hospital. 158 patients who had not been treated with thrombolytic treatment were divided into the treatment group (limb ischemia post treatment group) and the control group according to the order of hospitalization. All the patients in the group were given routine treatment. The treatment group was given the limb ischemia treatment at the same time. The National Institutes of Health Stroke Scale (NIHSS) at 14 days and 3 months in the course of disease, the improved Rankin scale (m RS) at admission and the course of 3 months, and the clinical efficacy of two groups of patients at 14 days of disease. The NIHSS score in the 1. two groups was not statistically significant (P0.05) at the time of admission and the course of disease (P0.05), but there was a difference in the course of the disease for 3 months. Statistical significance (P0.05); 2. when the course of disease was 3 months, the m RS score of the limb ischemic post treatment group was lower than the control group, the difference was statistically significant (P0.05); the total effective rate of the limb ischemic post-treatment group (95.9%) was higher than the control group (95.9%) at 14 days (95.9%), the difference was statistically significant (P0.05). Conclusion 1. limb ischemia post treatment Improvement of NIHSS score and m RS score in patients with acute cerebral infarction 2. limb ischemic post-treatment can improve the clinical efficacy of acute cerebral infarction patients. The effect of second part of limb ischemic postconditioning on cerebral infarction volume and cerebral perfusion in patients with acute cerebral infarction The methods of influence of death volume and cerebral perfusion were selected and treated in the one area of Neurology in Henan Province People's Hospital in June ~2016 March 2015, and 136 patients with acute cerebral infarction completed the whole limb ischemic post treatment cycle and followed up on time as the research object. The related data of the patients were collected by the special person. Siemens Trio was used. The patients were scanned by the Tim 3.0T superconducting general magnetic resonance scanner. All the patients were enrolled in the hospital (within 72 hours of onset), the course of the disease was 14 days, the course of the disease was 1 months, and the related examination of magnetic resonance was completed at the course of 3 months. At the time of admission, the course of the disease was 14 days, the course of the disease was 1 and the course of the disease was 3 months, and the course of illness was 14 days when the hospital was admitted. Relative PWI parameters at 3 months. Results 1. at 1 months and 3 months in the course of disease, the infarct volume in the limb ischemic post treatment group decreased by 36% and 34% in the control group (P0.05), and the RR CBV, RR CBF, R MTT and R TTP were no significant difference between the admission and the course 14 days. The difference between 3 months was statistically significant (P0.05). Conclusion 1. limb ischemic post-treatment can reduce the volume of cerebral infarction in patients with acute cerebral infarction and the post-treatment of.2. limb ischemia can improve the cerebral perfusion in patients with acute cerebral infarction.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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