【摘要】：目的1探討遠(yuǎn)隔肢體缺血后適應(yīng)(LIPost C)對(duì)急性腦梗死患者短期預(yù)后的效果及對(duì)肌酶水平的影響。2分析研究遠(yuǎn)隔肢體缺血后適應(yīng)(LIPost C)在腦梗死TOAST分型、OCSP分型、MRI分型、CISS分型中對(duì)不同亞型腦梗死短期預(yù)后的影響,選擇最佳適應(yīng)證。方法實(shí)驗(yàn)分兩個(gè)部分:1收集2014年4月份至2015年4月份就診于華北理工大學(xué)附屬醫(yī)院神經(jīng)內(nèi)科二病區(qū)、神經(jīng)內(nèi)科四病區(qū)及神經(jīng)重癥急性腦梗死患者220例,發(fā)病均在三天以?xún)?nèi)(不合并急性心梗),其中男性153例,年齡62.50±11.50歲,女性67例,年齡66.52±9.72歲。對(duì)照組給予常規(guī)治療,實(shí)驗(yàn)組在常規(guī)治療基礎(chǔ)上加用遠(yuǎn)隔肢體缺血后適應(yīng)(LIPost C)干預(yù)。比較2組治療7天時(shí)的NIHSS評(píng)分和ADL評(píng)分,比較兩組7天時(shí)血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和尿酸(UA)水平的變化。2連續(xù)收集2014年4月至2016年11月進(jìn)行遠(yuǎn)隔肢體缺血后適應(yīng)患者545例,其中男性378例,年齡63.78±11.47歲,女性167例,年齡63.74±10.47歲,比較遠(yuǎn)隔肢體缺血后適應(yīng)(LIPost C)對(duì)急性腦梗死TOAST分型、OCSP分型、MRI分型、CISS分型中不同亞型腦梗死短期預(yù)后的影響。結(jié)果第一部分實(shí)驗(yàn)結(jié)果1實(shí)驗(yàn)組7天時(shí)NIHSS評(píng)分為2.09±1.98,低于對(duì)照組2.75±2.66,2組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);實(shí)驗(yàn)組7天時(shí)ADL評(píng)分為91.73±12.73,高于對(duì)照組86.86±21.19。2實(shí)驗(yàn)組治療7d時(shí)血清CK、CK-MB分別是79.13±33.38 U/L、10.77±3.68 U/L,對(duì)照組分別是97.69±55.18 U/L、11.92±4.06U/L,分別低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。7d時(shí)尿酸水平2組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。第二部分實(shí)驗(yàn)結(jié)果1在TOAST分型和CISS分型中,LIPost C在各亞型間的顯效率無(wú)明顯差別。2在OCSP分型中,LIPost C在TACI、PACI亞型與其他亞型比較,臨床治療效果好(P0.01)。3在MRI分型中,LIPost C在大梗死型組臨床效果較小梗死型組預(yù)后好。結(jié)論1遠(yuǎn)隔缺血后適應(yīng)干預(yù)能改善急性腦梗死患者的神經(jīng)功能缺損程度,是一種安全的干預(yù)方式。2遠(yuǎn)隔肢體缺血后適應(yīng)在腦梗死TOAST分型和CISS分型中,對(duì)不同亞型腦梗死短期預(yù)后的影響類(lèi)似。但在腦梗死OCSP分型和MRI分型中,對(duì)不同亞型腦梗死短期預(yù)后產(chǎn)生不同的影響,前循環(huán)閉塞型效果較好,大面積梗塞型優(yōu)于小面積梗塞型。提示LIPost C應(yīng)在適宜的、有選擇的腦梗死亞型中應(yīng)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 鹵11.50 years old) and 67 females (66.52 鹵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 鹵11.47 years and 167 females. The age of 63.74 鹵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 鹵1.98 on the 7th day, which was lower than that of the control group (2.75 鹵2.66) (P0.05). The ADL score of the experimental group was 91.73 鹵12.73 on the 7th day, which was higher than that of the control group (86.86 鹵21.19.2). The serum CK,CK-MB of the experimental group was 79.13 鹵33.38 U / L 10.77 鹵3.68 U / L, respectively. The control group was 97.69 鹵55.18 UL / L 11.92 鹵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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.3

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