标题：体外反搏技术对急性缺血性卒中的治疗作用

      作者：梅麒，谢伟坚，张业昆，莫秀英，陈明濠，蔡玉屏    (广州市番禺区何贤纪念医院神经内科，广东 广州 511400)

      卷次： 2018年29卷20期

      【摘要】 目的 观察体外反搏技术对急性脑梗死患者的治疗作用。方法 选取广州市番禺区何贤纪念医院2017年 1~12月老年急性脑梗死患者 86例，按照随机数表法分为观察组和对照组，每组 43例。对照组患者进行常规抗血小板、稳定斑块、调控血压、血糖等相关治疗,观察组患者则在常规治疗基础上加用体外反搏治疗，两组均连续治疗 14 d；分别于治疗前后采用美国国立卫生研究院卒中量表(NIHSS评分)和改良残障水平评定量表(mRS评分)对两组患者进行评价，同时比较治疗前后两组患者梗死区及相对称区域的局部脑血流(rCBF)的变化情况。结果 (1)治疗前，观察组和对照组患者的NIHSS评分[(11.26±2.16)分 vs (11.32±2.11)分]和mRS评分[(3.92±0.74)分 vs (3.80±0.68)分]比较，差异均无统计学意义(P>0.05)；治疗后，观察组和对照组患者的NIHSS评分[(4.67±1.25)分 vs (6.88±1.05)分]和mRS评分[(2.23±0.81)分 vs (3.00±0.82)分]较治疗前均有所降低，且观察组患者的 NIHSS评分和mRS评分显著低于对照组，差异均有统计学意义(P<0.05)；(2)治疗前，观察组和对照组患者梗死区 rCBF值分别为[(20.23±1.77) mL/(100 g·min)和(20.86±1.69) mL/(100 g·min)]，两组间比较差异无统计学意义(P>0.05)；治疗后，观察组和对照组患者梗死区 rCBF值分别为(26.03±2.25) mL/(100 g·min)和(24.16±2.40) mL/(100 g·min)，较治疗前均有所增加，且观察组较对照组增加更加明显，差异均有统计学意义(P<0.05)；(3)治疗前，观察组和对照组患者的健侧rCBF值分别为[(50.49±5.63) mL/(100 g·min)和(50.86±4.20) mL/(100 g·min)]，组间比较差异无统计学意义(P>0.05)；治疗后，观察组和对照组患者的健侧的 rCBF值分别为[(51.30±4.35) mL/(100 g·min)和(52.72±8.62) mL/(100 g·min)]，治疗前后组内比较和治疗后组间健侧 rCBF值比较，差异均无统计学意义(P>0.05)。结论 辅助体外反搏治疗能够进一步加强脑梗死患者梗死区域的脑血流灌注，改善患者预后。
      【关键词】 急性脑梗死；缺血性卒中；体外反搏；局部脑血流；疗效
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2827—04

Clinical effects of external counter-pulsation in the treatment of acute ischemic stroke.
MEI Qi, XIE Wei-jian,ZHANG Ye-kun, MO Xiu-ying, CHEN Ming-hao, CAI Yu-ping. Hexian Memorial Hospital of Panyu District of Guangzhou,Guangzhou 511400, Guangdong, CHINA
【Abstract】 Objective To observe the clinical effects of external counter-pulsation in the treatment of patientswith acute cerebral infarction (ACI). Methods A total of 86 ACI patients in Hexian Memorial Hospital of Panyu Dis-trict of Guangzhou from Jan. 2017 to Dec. 2017 were selected and randomly divided into two groups: the observationgroup and the control group, with 43 patients in each group. Patients in the control group were treated in conventionalway, while those in the observation group were treated additionally with external counter-pulsation (ECP). The twogroups were both treated for 14 days continually. All patients were evaluated with National Institute of Health strokescale (NIHSS) score and modified Rankin Scale (mRS) score before and after the 14-day treatment. Regional cerebralblood flow (rCBF) in the infected side and the contralateral side before and after treatment were compared betweenthe two groups. Results (1) Before treatment, the NIHSS score and mRS scores were (11.26±2.16) and (3.92±0.74)in the observation group versus (11.32±2.11) and (3.80±0.68) in the control group (P>0.05). After the treatment, theNIHSS score and mRS scores were (4.67 ± 1.25) and (2.23 ± 0.81) in the observation group versus (6.88 ± 1.05) and(3.01±0.82) in the control group (P<0.05), which were all decreased significantly compared with those before treat-ment (P<0.05). (2) For the infected side, the rCBF was (20.23±1.77) mL/(100 g·min) in the observation group versus(20.86 ± 1.69) mL/(100 g·min) in the control group before treatment (P>0.05), and the values were significantly in-creased (P<0.05) to (26.03±2.25) mL/(100 g·min) in the observation group versus (24.16±2.40) mL/(100 g·min) in thecontrol group after the treatment. The increase in the observation group was more remarkable (P<0.05). (3) For the contra-lateral sides, the rCBF was (50.49±5.63) mL/(100 g·min) in the observation group versus (50.86±4.20) mL/(100 g·min) inthe control group before treatment (P>0.05), and (51.30 ± 4.35) mL/(100 g·min) in the observation group versus(52.72±8.62) mL/(100 g·min) in control group after treatment (P>0.05). There was no significant difference in rCBF forthe contralateral sides before and after treatment (P>0.05). Conclusion ECP can strengthen the cerebral blood flow ofthe infarction region and improve the prognosis of the ACI patients.
      【Key words】 Acute cerebral infarction (ACI); Ischemic stroke (IS); External counter-pulsation (ECP); Regionalcerebral blood flow (rCBF); Clinical effects·论 著·doi:10.3969/j.issn.1003-6350.2018.20.005基金项目：广东省广州市番禺区科技计划项目(编号：2017-Z0