黃 超，任向陽(yáng)，周海濤，馬聰敏，滕軍放

?

·論著·

上肢遠(yuǎn)程缺血后適應(yīng)治療對(duì)急性腦梗死神經(jīng)功能及預(yù)后的影響研究

黃 超，任向陽(yáng)，周海濤，馬聰敏，滕軍放

目的探討上肢遠(yuǎn)程缺血后適應(yīng)治療對(duì)急性腦梗死神經(jīng)功能及預(yù)后的影響。方法選取2013年1月—2015年1月鄭州大學(xué)附屬洛陽(yáng)中心醫(yī)院診斷為急性腦梗死的患者160例為研究對(duì)象，采用隨機(jī)數(shù)字表法分為兩組：對(duì)照組80例，予以常規(guī)藥物治療及正規(guī)康復(fù)訓(xùn)練；治療組80例，予以常規(guī)藥物治療、正規(guī)康復(fù)訓(xùn)練及上肢遠(yuǎn)程缺血后適應(yīng)治療。兩組患者于治療前及治療14 d后進(jìn)行美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分、經(jīng)顱多普勒(TCD)檢查，治療3個(gè)月后進(jìn)行改良Rankin量表(mRs)評(píng)分。平均隨訪(fǎng)(24.5±7.6)個(gè)月，統(tǒng)計(jì)兩組患者終點(diǎn)事件〔短暫性腦缺血發(fā)作(TIA)、再發(fā)腦梗死、腦出血、心血管事件(急性冠脈綜合征、心肌梗死)〕發(fā)生率。結(jié)果治療前及治療14 d后，對(duì)照組與治療組NIHSS評(píng)分比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。治療3個(gè)月后治療組mRs評(píng)分0～1分41例(51.2%)，對(duì)照組mRs評(píng)分0～1分28例(35.0%)，兩組患者mRs評(píng)分0～1分者所占比例比較，差異有統(tǒng)計(jì)學(xué)意義(χ2=4.306，P=0.038)。治療前，對(duì)照組與治療組顳窗病變側(cè)大腦中動(dòng)脈和枕窗基底動(dòng)脈搏動(dòng)指數(shù)(PI)比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)；治療14 d后，治療組顳窗病變側(cè)大腦中動(dòng)脈和枕窗基底動(dòng)脈PI較對(duì)照組降低(P<0.05)。對(duì)照組與治療組再發(fā)腦梗死、腦出血發(fā)生率比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)；治療組患者TIA、心血管事件發(fā)生率較對(duì)照組降低(P<0.05)。治療組患者上肢遠(yuǎn)程缺血后適應(yīng)治療過(guò)程中均未出現(xiàn)血壓、心率、呼吸的改變，未出現(xiàn)其他不適感。結(jié)論上肢遠(yuǎn)程缺血后適應(yīng)治療可以改善急性腦梗死患者的神經(jīng)功能及腦血管的順應(yīng)性，提高腦血流的儲(chǔ)備能力，降低TIA及心血管事件的發(fā)生率，操作簡(jiǎn)單易行，具有較好的臨床應(yīng)用前景。

腦梗死；遠(yuǎn)程缺血后適應(yīng)；美國(guó)國(guó)立衛(wèi)生研究院卒中量表；預(yù)后

黃超，任向陽(yáng)，周海濤，等.上肢遠(yuǎn)程缺血后適應(yīng)治療對(duì)急性腦梗死神經(jīng)功能及預(yù)后的影響研究[J].中國(guó)全科醫(yī)學(xué)，2016，19(23)：2767-2770.[www.chinagp.net]

HUANG C,REN X Y,ZHOU H T,et al.Influence of remote ischemic post-conditioning therapy of upper limb on neurological function and prognosis of acute cerebral infarction[J].Chinese General Practice，2016，19(23)：2767-2770.

目前，在腦梗死發(fā)生后，仍缺乏有效的干預(yù)措施以保護(hù)神經(jīng)元及促進(jìn)神經(jīng)功能的修復(fù)[1]。缺血再灌注損傷時(shí)給予不同器官短暫的非致死性缺血和再灌注損傷，稱(chēng)為遠(yuǎn)程缺血后適應(yīng)(remote ischemic post-conditioning)[2]。目前動(dòng)物實(shí)驗(yàn)證實(shí)，遠(yuǎn)程缺血后適應(yīng)可以減輕腦缺血再灌注損傷，維持血-腦脊液屏障穩(wěn)定性[3]，但國(guó)內(nèi)相關(guān)的臨床研究較少，本研究通過(guò)早期采用上肢遠(yuǎn)程缺血后適應(yīng)治療急性腦梗死患者，旨在探討上肢遠(yuǎn)程缺血后適應(yīng)治療對(duì)急性腦梗死神經(jīng)功能及預(yù)后的影響。

1　對(duì)象與方法

1.1研究對(duì)象選取2013年1月—2015年1月鄭州大學(xué)附屬洛陽(yáng)中心醫(yī)院診斷為急性腦梗死的患者160例為研究對(duì)象，其中男86例，女74例；年齡43～78歲，平均年齡(59.4±9.8)歲；合并高血壓79例，高脂血癥56例，冠心病52例，糖尿病50例。發(fā)病時(shí)間24～72 h，既往無(wú)腦梗死病史，美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分≤12分，無(wú)嚴(yán)重的心肺疾病。本研究經(jīng)醫(yī)院倫理委員會(huì)批準(zhǔn)，患者均知情并同意。

1.2診斷標(biāo)準(zhǔn)急性腦梗死診斷標(biāo)準(zhǔn)：急性起病，伴有神經(jīng)功能缺損的癥狀，如言語(yǔ)不清、偏癱、偏盲、偏身感覺(jué)障礙等，癥狀持續(xù)不能緩解，顱腦磁共振彌散加權(quán)成像(DWI)可見(jiàn)急性期腦梗死病灶。

1.3分組采用隨機(jī)數(shù)字表法將患者分為兩組：對(duì)照組80例，予以常規(guī)藥物治療及正規(guī)康復(fù)訓(xùn)練；治療組80例，予以常規(guī)藥物治療、正規(guī)康復(fù)訓(xùn)練及上肢遠(yuǎn)程缺血后適應(yīng)治療。兩組患者性別、年齡、高血壓、高脂血癥、冠心病、糖尿病檢出率比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05，見(jiàn)表1)。

表1　對(duì)照組與治療組患者一般資料比較

注：a為t值

1.4治療方法

1.4.1對(duì)照組住院期間予以常規(guī)藥物治療及正規(guī)康復(fù)訓(xùn)練。常規(guī)藥物治療為抗血小板聚集(如阿司匹林腸溶片、氯吡格雷片等)、降血脂、穩(wěn)定斑塊、穩(wěn)定血壓、改善循環(huán)、擴(kuò)血管的藥物。出院后，給予二級(jí)預(yù)防及正規(guī)康復(fù)訓(xùn)練治療，康復(fù)訓(xùn)練方案由本院康復(fù)科主治醫(yī)師制定，工作5年以上的康復(fù)師執(zhí)行。

1.4.2治療組住院期間在常規(guī)治療及正規(guī)康復(fù)訓(xùn)練的基礎(chǔ)上，予以上肢遠(yuǎn)程缺血后適應(yīng)治療，水銀血壓計(jì)袖帶放置于一側(cè)上臂上端，加壓至200 mm Hg(1 mm Hg=0.133 kPa)，缺血5 min，再灌注5 min，連續(xù)重復(fù)5次，1次/d。出院后，仍每天堅(jiān)持上肢遠(yuǎn)程缺血后適應(yīng)治療至3個(gè)月，并予以二級(jí)預(yù)防及正規(guī)康復(fù)訓(xùn)練治療。

1.5觀(guān)察指標(biāo)兩組患者于治療前及治療14 d后進(jìn)行NIHSS評(píng)分、經(jīng)顱多普勒(TCD)檢查，治療3個(gè)月后進(jìn)行改良Rankin量表(mRs)評(píng)分。TCD以顳窗病變側(cè)大腦中動(dòng)脈和枕窗基底動(dòng)脈搏動(dòng)指數(shù)(PI)作為觀(guān)察指標(biāo)。平均隨訪(fǎng)(24.5±7.6)個(gè)月，統(tǒng)計(jì)兩組患者終點(diǎn)事件〔短暫性腦缺血發(fā)作(TIA)、再發(fā)腦梗死、腦出血、心血管事件(急性冠脈綜合征、心肌梗死)〕發(fā)生率。

2　結(jié)果

2.1NIHSS及mRs評(píng)分治療前及治療14 d后，對(duì)照組與治療組NIHSS評(píng)分比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05，見(jiàn)表2)。治療3個(gè)月后治療組mRs評(píng)分0～1分41例(51.2%)，對(duì)照組mRs評(píng)分0～1分28例(35.0%)，兩組患者mRs評(píng)分0～1分者所占比例比較，差異有統(tǒng)計(jì)學(xué)意義(χ2=4.306，P=0.038)。

Table 2Comparison of NIHSS score between the two groups before treatment and 14 days after treatment

組別例數(shù)治療前治療14d后對(duì)照組805.6±3.34.4±3.0治療組804.9±2.53.4±2.1t值0.7311.178P值0.4690.246

2.2顳窗病變側(cè)大腦中動(dòng)脈和枕窗基底動(dòng)脈PI治療前，對(duì)照組與治療組顳窗病變側(cè)大腦中動(dòng)脈和枕窗基底動(dòng)脈PI比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)；治療14 d后，治療組顳窗病變側(cè)大腦中動(dòng)脈和枕窗基底動(dòng)脈PI較對(duì)照組降低，差異均有統(tǒng)計(jì)學(xué)意義(P<0.05，見(jiàn)表3)。

Table 3Comparison of PI of the middle cerebral artery in the lesion side of the temporal window and the basilar artery of the suboccipital window between the two groups before treatment and 14 days after treatment

組別例數(shù) 顳窗病變側(cè)大腦中動(dòng)脈PI治療前 治療14d后 枕窗基底動(dòng)脈PI治療前 治療14d后對(duì)照組800.89±0.170.86±0.160.90±0.170.85±0.14治療組800.89±0.190.76±0.120.87±0.170.74±0.12t值0.0332.0770.5832.385P值0.9740.0450.5640.022

注：PI=搏動(dòng)指數(shù)

2.3終點(diǎn)事件對(duì)照組與治療組再發(fā)腦梗死、腦出血發(fā)生率比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)；治療組患者TIA、心血管事件發(fā)生率較對(duì)照組降低，差異均有統(tǒng)計(jì)學(xué)意義(P<0.05，見(jiàn)表4)。

2.4安全性評(píng)估治療組患者上肢遠(yuǎn)程缺血后適應(yīng)治療過(guò)程中均未出現(xiàn)血壓、心率、呼吸的改變，未出現(xiàn)其他不適感。

表4對(duì)照組與治療組終點(diǎn)事件發(fā)生率比較〔n(%)〕

Table 4Comparison of the incidence rates of the outcome events between the two groups

組別例數(shù)TIA再發(fā)腦梗死腦出血心血管事件對(duì)照組8010(12.5)6(7.5)2(2.5)11(13.8)治療組803(3.7)4(5.0)3(3.7)3(3.8)χ2值4.1030.4270.2065.010P值0.0430.5140.6500.025

注：TIA=短暫性腦缺血發(fā)作

3　討論

本研究針對(duì)急性腦梗死患者，采用短暫肢體缺血的方法行上肢遠(yuǎn)程缺血后適應(yīng)治療，患者均耐受性良好，無(wú)特殊不適。治療14 d后，TCD檢查證實(shí)治療組顳窗病變側(cè)大腦中動(dòng)脈和枕窗基底動(dòng)脈PI有所下降，表明腦血管的反應(yīng)性有所改善，腦血流的儲(chǔ)備能力有所提高。治療3個(gè)月后治療組患者mRs評(píng)分0～1分者所占比例較對(duì)照組升高，表明上肢遠(yuǎn)程缺血后適應(yīng)治療可以改善急性腦梗死患者的預(yù)后。

國(guó)內(nèi)外針對(duì)遠(yuǎn)程缺血后適應(yīng)治療與腦梗死方面的研究多處于動(dòng)物實(shí)驗(yàn)階段，這些實(shí)驗(yàn)表明遠(yuǎn)程缺血后適應(yīng)治療可以減少大鼠腦梗死的面積，減輕腦水腫及缺血再灌注損傷，維持血-腦脊液屏障的穩(wěn)定性，促進(jìn)神經(jīng)功能的恢復(fù)[4-7]，提示遠(yuǎn)程缺血后適應(yīng)治療具有較高的臨床應(yīng)用價(jià)值。目前丹麥有一項(xiàng)關(guān)于急性腦梗死患者院前遠(yuǎn)程缺血后適應(yīng)治療的臨床研究正在開(kāi)展，其通過(guò)顱腦磁共振灌注成像及彌散加權(quán)成像的匹配程度，評(píng)估遠(yuǎn)程缺血后適應(yīng)治療對(duì)缺血半暗帶的影響，以明確遠(yuǎn)程缺血后適應(yīng)治療的腦保護(hù)作用，但相關(guān)試驗(yàn)結(jié)果尚未發(fā)表[8]。國(guó)內(nèi)的一項(xiàng)通過(guò)TCD評(píng)估遠(yuǎn)程缺血后適應(yīng)治療對(duì)腦血流影響的研究表明，遠(yuǎn)程缺血后適應(yīng)治療可以增加基底動(dòng)脈的血流，從而改善腦灌注[9]。雖然研究對(duì)象、評(píng)估方法有所不同，但本研究亦證實(shí)上肢遠(yuǎn)程缺血后適應(yīng)治療可以提高急性腦梗死患者大腦對(duì)缺血缺氧的耐受能力，改善預(yù)后，具有腦保護(hù)作用，而且操作簡(jiǎn)單、安全，患者耐受性良好。

隨訪(fǎng)過(guò)程中，治療組患者TIA及心血管事件的發(fā)生率明顯低于對(duì)照組。對(duì)再發(fā)心腦血管事件而言，此次上肢遠(yuǎn)程缺血后適應(yīng)治療亦可作為預(yù)適應(yīng)治療，可通過(guò)骨骼肌缺血產(chǎn)生內(nèi)源性保護(hù)作用進(jìn)而減輕局部組織或器官隨后長(zhǎng)時(shí)間缺血再灌注損傷，而且對(duì)遠(yuǎn)端的腦、心臟、肝臟、腎、胰腺等組織器官也具有保護(hù)作用，可改善缺血性腦血管病患者的癥狀，提高腦組織對(duì)缺血的耐受性,降低腦梗死復(fù)發(fā)率[10-11]。本研究隨訪(fǎng)期內(nèi)，治療組患者再發(fā)腦梗死、腦出血發(fā)生率較對(duì)照組無(wú)明顯降低，但治療組TIA、心血管事件發(fā)生率明顯降低。延長(zhǎng)隨訪(fǎng)時(shí)間，增加入組病例數(shù)，能更明確兩組之間的差異。

腦缺血后適應(yīng)治療的保護(hù)機(jī)制目前尚不清楚，可能與Akt信號(hào)轉(zhuǎn)導(dǎo)通路、絲裂原活化蛋白激酶(MAPK)信號(hào)轉(zhuǎn)導(dǎo)通路、蛋白激酶C(PKC)信號(hào)轉(zhuǎn)導(dǎo)通路、KATP信號(hào)轉(zhuǎn)導(dǎo)通路、機(jī)械信號(hào)轉(zhuǎn)導(dǎo)通路的作用有關(guān)，最終減少神經(jīng)元凋亡，保護(hù)缺血腦組織[12-13]。亦有研究表明，遠(yuǎn)程缺血后適應(yīng)治療可以通過(guò)下調(diào)星形膠質(zhì)細(xì)胞中水通道蛋白4(AQP4)的表達(dá)來(lái)改善神經(jīng)功能[6]。遠(yuǎn)程缺血后適應(yīng)治療的腦保護(hù)作用可分為急性期和延遲期兩個(gè)階段，急性保護(hù)作用發(fā)生在最初的幾分鐘，通過(guò)促使殘存系統(tǒng)內(nèi)蛋白質(zhì)翻譯后修飾(比如磷酸化作用)而產(chǎn)生，并于幾小時(shí)內(nèi)消退，延遲保護(hù)作用通過(guò)促進(jìn)參與血管生成、能量代謝、血管收縮、炎癥和細(xì)胞生存(比如生長(zhǎng)因子)的休眠基因蛋白合成而發(fā)揮，發(fā)生于24 h以后，并可以持續(xù)1周[12]。

目前，遠(yuǎn)程缺血后適應(yīng)治療的腦保護(hù)作用臨床研究較少，本研究初步證實(shí)上肢遠(yuǎn)程缺血后適應(yīng)治療可改善急性腦梗死患者的預(yù)后，且其操作簡(jiǎn)單易行，具有較好的臨床應(yīng)用前景。但為提高患者隨訪(fǎng)的依從性，此次入組均為NIHSS≤12分者，樣本量少，隨訪(fǎng)時(shí)間短，且無(wú)法完全排除恢復(fù)期，患者家庭、經(jīng)濟(jì)、性格、環(huán)境、看護(hù)人等方面的影響，療效評(píng)估方法相對(duì)簡(jiǎn)單，臨床療效的觀(guān)察存在一定的局限性，需繼續(xù)擴(kuò)大樣本量，密切隨訪(fǎng)參與研究的患者，以更好地研究上肢遠(yuǎn)程缺血后適應(yīng)治療的有效性與安全性，促進(jìn)缺血性腦血管病防治研究的發(fā)展。

作者貢獻(xiàn)：黃超進(jìn)行試驗(yàn)設(shè)計(jì)與實(shí)施、資料收集整理、撰寫(xiě)論文、成文并對(duì)文章負(fù)責(zé)；任向陽(yáng)、周海濤、馬聰敏進(jìn)行試驗(yàn)實(shí)施、評(píng)估、資料收集；滕軍放進(jìn)行質(zhì)量控制及審校。

本文無(wú)利益沖突。

[1] JAUCH E C，SAVER J L,ADAMS H P，et al.Guidelines for the early management of patients with acute ischemic stroke：executive summary a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke，2013，44(3)：870-947.

[2]MENG R,ASMARO K,MENG L,et al.Upper limb ischemic preconditioning prevents recurrent stroke in intracranial arterial stenosis[J].Neruology,2012,79(18):1853-1861.

[3] 楊世亮，周曉明，譚帥，等.遠(yuǎn)程缺血后適應(yīng)對(duì)腦缺血再灌注大鼠血腦屏障的保護(hù)作用[J].中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)版),2015，36(3):371-376.

YANG S L,ZHOU X M,TAN S,et al.Protective effects of remote ischemic postconditioning on blood brain barrier in focal cerebral ischemia reperfusion rats[J].Journal of Sun Yat-sen University(Medical Sciences),2015，36(3):371-376.

[4]CANDILIO L,MALIK A,HAUSENLOY D J.Protection of organs other than the heart by remote ischemic conditioning[J].J Cardiovasc Med(Hagerstown),2013,14(3):193-205.

[5]REN C,GAO M,DORNBOS D 3rd,et al.Remote ischemic post-conditioning reduced brain damage in experimental ischemia/reperfusion injury[J].Neurol Res,2011,33(5):514-519.

[6]LI S,HU X,ZHANG M,et al.Remote ischemic post-conditioning improves neurological function by AQP4 down-regulation in astrocytes[J].Behav Brain Res,2015,289:1-8.

[7]DIRNAGL U，BECKER K，MEISEL A.Preconditioning and tolerance against cerebral isehaemia：from experimental strategies to clinical use[J].Lancet Neurol，2009，8(4)：398-412.

[8]HESS D C,HODA M N,BHATIA K.Remote limb preconditioning[corrected] and postconditioning：will it translate into a promising treatment for acute stroke？[J].Stroke,2013,44(4):1191-1197.

[9] 吳懷國(guó)，侯慶兵，王書(shū)培，等.遠(yuǎn)程肢體缺血后適應(yīng)對(duì)腦血流的影響[J].中華腦血管病雜志(電子版)，2013,7(6)：305-309.

WU H G,HOU Q B,WANG S P,et al.Effects of remote limb ischemic postconditioning on cerebral blood flow[J].Chinese Journal of Cerebravascular Disease(Electronic Edition),2013,7(6):305-309.

[10]DEFTEREOS S,GIANNOPOULOS G,TZALAMOURAS V,et al.Renoprotective effect of remote ischemic post-conditioning by intermittent balloon inflations in patients undergoing percutaneous coronary intervention[J].J Am Coll Cardiol,2013,61(19):1949-1955.

[11]HOUGAARD K D,HJORT N，ZEIDLER D，et al.Remote ischemic perconditioning in thrombolysed stroke patients：randomized study of activating endogenous neuroprotection-design and MRI measurements[J].Int J Stroke,2013,8(2):141-146.

[12]DEZFULIAN C,GARRETT M,GONZALEZ N R.Clinical application of preconditioning and postconditioning to achieve neuroprotection[J].Transl Stroke Res,2013,4(1):19-24.

[13] 張川蕘，李樹(shù)清.腦缺血后適應(yīng)腦保護(hù)的研究進(jìn)展[J].中國(guó)病理生理雜志，2011，27(5):1025-1028,1040.

ZHANG C R,LI S Q.Progress in brain protection with ischemic postconditioning[J].Chinese Journal of Pathophysiology,2011,27(5):1025-1028,1040.

(本文編輯：陳素芳)

Influence of Remote Ischemic Post-conditioning Therapy of Upper Limb on Neurological Function and Prognosis of Acute Cerebral Infarction

HUANGChao,RENXiang-yang,ZHOUHai-tao,MACong-min,TENGJun-fang.

DepartmentofNeurology,LuoyangCentralHospitalAffiliatedtoZhengzhouUniversity,Luoyang471000,China

TENGJun-fang,DepartmentofNeurology,theFirstAffiliatedHospitalofZhengzhouUniversity,Zhengzhou450052,China；E-mail:13838210077@163.com

ObjectiveTo discuss the influences of remote ischemic post-conditioning(RIPC) therapy of upper limb on the neurological function and prognosis of acute cerebral infarction.Methods160 patients who were diagnosed as acute cerebral infarction from January 2013 to January 2015 in Luoyang Central Hospital Affiliated to Zhengzhou University were selected as the research objects.By random number table method,we divided these participants into two groups:the control group of 80 patients receiving routine drug therapy and formal rehabilitation training and the treatment group of 80 patients receiving routine drug therapy,formal rehabilitation training and RIPC of upper limb.National Institutes of Health Stroke Scale(NIHSS) and TCD examination were given to the patients of the two groups before treatment and 14 days after treatment,and modified Rankin scale(mRs) score was performed 3 months after treatment.Patients were then followed up(24.5±7.6) months to measure the incidence rate of outcome events including transient ischemic attack(TIA),recurrent cerebral infarction，cerebral hemorrhage,cardiovascular events(acute coronary syndrome and myocardial infarction).ResultsThere was no significant difference in NIHSS between the two groups before treatment and 14 days after treatment(P>0.05).3 months after treatment,there were 41(51.2%)cases in the treatment group with the mRs score varying from 0 to 1,and 28(35.0%) cases in the control group.There was significant difference in the ratio of patients with mRs score varying from 0 to 1 of the two groups(χ2=4.306,P=0.038).Before treatment,the two groups were no significantly different in pulsatility index(PI) of the middle cerebral artery(MCA) in the lesion side of temporal window and basilar artery(BA) of suboccipital window(P>0.05);14 days after treatment,PI of the MCA in the lesion side of temporal window and the BA of the suboccipital window of the treatment group lowered compared with the control group(P<0.05).There were no significant difference in the incidence rates of recurrent cerebral infarction and cerebral hemorrhage between the control group and the treatment group(P>0.05);compared with the control group,the incidence rates of TIA and cardiovascular events of patients in the treatment group lowered(P<0.05).There were no changes in patients′ blood pressure,heart rate and respiration in the treatment group during the RIPC therapy of upper limb,and the patients did not feel any discomfortableness during the treatment of RIPC of upper limb.ConclusionRIPC of upper limb can improve the neurological function of the acute cerebral infarction patients and the cerebrovascular compliance,reserve capacity of cerebral blood flow,and reduce the occurrence rate of TIA and cardiovascular events.The operation is simple and easy,which has bright clinical application prospects.

Brain infarction；Remote ischemic post-conditioning；NIHSS；Prognosis

471000河南省洛陽(yáng)市，鄭州大學(xué)附屬洛陽(yáng)中心醫(yī)院神經(jīng)內(nèi)科(黃超，任向陽(yáng)，周海濤，馬聰敏)；鄭州大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科(滕軍放)

滕軍放，450052河南省鄭州市，鄭州大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科；E-mail:13838210077@163.com

R 743.33

A

10.3969/j.issn.1007-9572.2016.23.005

2015-12-16；

2016-06-07)