The Effect Of Remote Ischemic Postconditioning On Autonomic Nerve Function And Prognosis In Patients With Acute Ischemic Stroke

Rapid recovery of cerebral blood flow is the main method for the treatment of acute ischemic stroke,but the recovery of blood perfusion will also occur reperfusion injury,aggravating brain tissue damage.Remote ischemic post-conditioning(RIPostC)is a therapeutic method found in recent years to alleviate cerebral ischemia-reperfusion injury.The mechanism may be related to neural pathways,especially autonomic nervous system,but it has not been confirmed by clinical studies.Therefore,the purpose of this study was to investigate the effect of RIPostC in the treatment of acute ischemic stroke and the mechanism of autonomic nerve action.It is divided into two parts:(1)to investigate the therapeutic effect of RIPostC on ischemic stroke by meta analysis;(2)to investigate the effect of RIPostC on autonomic nerve function and prognosis in patients with acute ischemic stroke by prospective randomized controlled study.Chapter 1 Meta analysis of remote ischemic post-conditioning in the treatment of ischemic strokeObjective:To investigate the therapeutic effect of RIPostC on acute ischemic stroke by meta analysis.Methods:The databases of CNKI,Wanfang,VIP,CBM,PubMed and Cochrane libraries were searched from January 1980 to July 2016.The fixed effect and random effect models of ReviewManager were used for analysis.Results:A total of 13 randomized controlled trials were selected,including 1251 patients with ischemic stroke.Compared with the control group,RIPostC significantly decreased the recurrence rate of stroke or transient ischemic attack(P<0.001),the stroke score of the National Institutes of Health(P<0.001)and the modified Rankin scale(P ≥ 0.002).The level of hypersensitive C-reactive protein was decreased(P<0.001).Conclusion:RIPostC can improve the prognosis and reduce the recurrence of ischemic stroke.Chapter 2 The effects of remote ischemic post-conditioning on autonomic nerve function and prognosis in patients with acute ischemic stroke.Objective:To investigate the effect of RIPostC on autonomic nerve function and prognosis in patients with acute ischemic stroke,and the mechanism of autonomic nerve in clinical efficacy.Methods:This study was a prospective randomized controlled placebo study.The patients with first ischemic stroke who were hospitalized from January 1,2016 to June 31,2017 and whose course of disease was ≤ 14 days were selected.The treatment group was treated with RIPostC and the control group was treated with false RIPostC for 30 days.Autonomic nervous function was measured by cardiac rhythm variability.Results:The results of repeated autonomic nerve measurement in the two groups showed that there was significant interaction between time and treatment of SDNN,pNN50 and HF(P<0.05);The increase of BI and the decrease of mRS in the experimental group were better than those in the control group(P<0.001).Multiple linear regression shows that pNN50 is an independent risk factor for BI score and mRS score on day 90(P<0.001).The analysis of generalized estimation equation showed that autonomic nerve was an important confounding factor affecting the curative effect of RIPostC.Further structural equation revealed that autonomic nerve was a complete mediator for RIPostC to reduce mRS score.Conclusion:RIPostC can improve limb disability function,daily living ability and clinical prognosis in patients with acute ischemic stroke.RIPostC can stimulate the activity of vagus nerve and the total activity of autonomic nerve.Autonomic nerve is an intermediary variable for RIPostC to improve mRS in patients with acute ischemic stroke...