远隔缺血适应对急性缺血性脑卒中患者脑血流动力学及近期预后的影响

Effects of remote ischemic conditioning on cerebral hemodynamics and short-term prognosis in patients with acute ischemic stroke

摘要:

目的 研究远隔缺血适应对急性缺血性脑卒中（AIS）患者脑血流动力学及近期预后的影响。方法 前瞻性纳入2024年12月—2025年4月合肥市第一人民医院神经内科收治的80例AIS患者，随机分为治疗组和对照组。对照组予以标准药物治疗，治疗组在标准药物治疗的基础上进行远隔缺血适应治疗，1次/d，连续7 d。对比入院时和治疗7 d时两组患者双侧大脑中动脉经颅多普勒超声检测指标变化，包括收缩期峰值流速、平均流速、舒张末流速、血管搏动指数及血管阻力指数。比较两组病程90 d的转归良好构成，改良Rankin量表0～1分定义为转归良好。结果 80例AIS患者中，68例（85%）完成了治疗，治疗组33例，对照组35例。两组的年龄、性别构成、吸烟构成、高血压构成、糖尿病构成、高脂血症构成、同型半胱氨酸水平、低密度脂蛋白胆固醇水平、入院时美国国立卫生研究院卒中量表（NIHSS）评分、入院时改良Rankin量表和病程90 d患者功能转归良好构成比较，差异均无统计学意义（P >0.05）。治疗组治疗后右侧大脑中动脉血管搏动指数及血管阻力指数均低于对照组（P <0.05），治疗组治疗前后右侧大脑中动脉血管搏动指数及血管阻力指数的差值均大于对照组（P <0.05）。结论 短期远隔缺血适应能够改善AIS患者的脑血流动力学，降低脑远端血管阻力，但对病程90 d的良好转归无明显影响，可能需要较长周期的适应性治疗以观察其近远期影响。

Abstract:

Objective To investigate the effect of remote ischemic conditioning (RIC) on cerebral hemodynamics and short-term prognosis in patients with acute ischemic stroke (AIS).Methods A total of 80 AIS patients admitted to the Department of Neurology, The First People's Hospital of Hefei from December 2024 to April 2025 were prospectively enrolled and randomly divided into the treatment group and the control group using a random number table. The control group received standard drug therapy, while the treatment group received RIC once daily for 7 consecutive days on the basis of standard drug therapy. Transcranial Doppler (TCD) parameters of the bilateral middle cerebral arteries (MCAs) were compared between the two groups at admission and on day 7 of the disease course, including peak systolic velocity (PSV), mean flow velocity(MFV), end-diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI). The proportion of patients with favorable outcomes at 90 days of the disease course was compared between the two groups; a modified Rankin Scale (mRS) score of 0 ~ 1 was defined as a favorable outcome.Results Among the 80 eligible AIS patients who were randomly assigned, 68 (85%) completed the trial, the treatment group 33 cases, the control group 35 cases. Baseline characteristics were well balanced between the treatment group and the control group. No statistically significant differences were found in age, gender composition, smoking rate, prevalence rates of hypertension, diabetes mellitus and hyperlipidemia, homocysteine level, low-density lipoprotein cholesterol level, National Institutes of Health Stroke Scale (NIHSS) score on admission, mRS score on admission, or the rate of favorable functional outcome at 90 days after onset (all P > 0.05). Significant differences were observed in the changes (before vs. after treatment) of PI and RI of the right middle cerebral artery between the two groups (both P < 0.05). Specifically, the changes in PI and RI values of the right middle cerebral artery before and after treatment in the treatment group were greater than those in the control group.Conclusion Short-term RIC can improve cerebral hemodynamics and reduce distal cerebral vascular resistance in AIS patients, but it has no significant effect on favorable outcomes at 90 days of the disease course. A longer course of adaptive treatment may be required to observe its short-term and long-term effects.