| Acute cerebral infarction(AIS,also known as acute ischemic stroke)has become the second largest cause of death worldwide over the age of 60,and its incidence rate remains high.And 20%～80%of the patients will have cognitive dysfunction,once the occurrence of cognitive dysfunction after cerebral infarction will make the quality of life of patients significantly impaired,to the family and society to bring a great burden.However,according to the literature,there is no effective treatment and nursing of vascular cognitive impairment.Distal limb ischemic adaptation(Limb remote ischemic conditioning,LRIC)therapy is a new physical therapy developed in recent years,which has the.effect of improving the tolerance and adaptability of heart,brain,kidney,liver and other important organs to hypoxia,especially in reducing the incidence of various types of ischemic organ diseases and improving the injury of tissues and organs by ischemia-reperfusion.Therefore,this study carried out remote limb ischemia adaptive nursing in patients with acute cerebral infarction to alleviate the occurrence of cognitive dysfunction after cerebral infarction,thus reducing the rate of disability and improving the quality of life of patients.[Objective]1.To verify the feasibility and safety of remote limb ischemic adaptive care.2.To explore the effect of remote limb ischemic adaptive nursing on cognitive function of patients with acute ischemic cerebral infarction and its possible mechanism,to find an effective method for the treatment of patients with acute ischemic cerebral infarction complicated with cognitive dysfunction,in order to improve the cognitive dysfunction of patients with acute ischemic cerebral infarction and promote the early recovery of patients.3.To observe the changes of biomarkers when cognitive dysfunction occurs in patients with acute ischemic cerebral infarction,find out the earliest changes and the most sensitive biomarkers,and provide reference for early prediction of cognitive dysfunction in the course of treating patients with acute cerebral infarction in the future.[Methods]We collected 50 patients with acute cerebral infarction from January 2019 to January 2020 who were admitted to the Department of Neurology and the Neurological intensive Care Unit of a third-class Hospital in Wuwei City,all of whom where within 48 hours,including 28 male patients,aged 66.25±7.38 years,22 female patients,aged 67±9.63 years.The patients who were admitted to the hospital and met the inclusion criteria were randomly divided into experimental group(25 cases)and the control group(25 cases)using the method of random table method.The patients in the control group were given routine treatment nursing,and the patients in the experimental group were given the adaptive intervention of the left and right upper limbs alternating ischemia on the basis of routine treatment nursing,the interventions are as follows:Use a sphygmomanometer cuff to quickly inflate one upper limb and pressurize to 200 mmhg,for 3 min,then deflate for 3 min.Inflate and deflate the upper limb on the other side by the same method,and use this as a cycle;the left and right upper limbs alternate for 3 consecutive cycles,2 times a day,and continue to intervene for 30 days.At last,the changes of Montreal Cognitive function score(montreal cognitive assessment,MOCA),serum homocysteine(homocysteine,HCY)were compared between the experimental group and control group,as well as in the patients before and after the intervention in the two groups,on the 7th,14th and 30th days in advance,and the distant limb deficiency was analyzed.[Result]1.Comparsion results of general informationAccording to the statistical analysis of the general data of the patients on admission,there was no significant difference in sex,age,past medical history,infarct location,education level between the experimental group and the control group(p>0.05).2.Comparison of cognitive functionThe results showed that:① the scores(MOCA)of the patients in the experiment group and the control group were whin 24 hours after admission was lower than the normal value,and the difference of scores between the two groups was not statistically significant(p>0.05),suggesting that both groups had cognitive dysfunction;②On the 7th,14th and 30th days after the intervention,the scores of MOCA in the experimental group were higher than those in the control group,and the difference was statistically significant(p<0.05),suggesting that LRIC therapy could significantly improve cognitive dysfunction in patients with acute cerebral infarction compared with conventional therapy;③The MOCA scores of the two groups showed an increasing trend after the beginning of the experiment,but the increase of the rate in the experimental group was higher than that in the control group(p<0.05),and the difference in the increase rate in the control group was not statistically significant(p>0.05).④On the 14th day after the intervention,the MOCA score of the experimental group had reached the level above the normal value,while the MOCAscore of the control group was still lower than the normal value.The results suggest that the early effect of LRIC intervention is more significant,and the cognitive dysfunction of patients with only 14 days course of treatment can be cured.This result can provide data support for the future clinical LRIC intervention and provide two technical indexes of starting time and course of treatment.3.Comparison of serum homocysteine(HCY)concentrationsThe results of comparison of HCY levels between the two groups were as follows:①at the time of admition,the HCY level of both groups exceeded the normal level,and there was no statistical difference(p>0.05),suggesting that serum homocysteine(HCY)level increased in patients with acute cerebral infarction with cognitive impairment;②On the 7th day,the concentration of HCY between the two groups decreased,but the decrease of the experimental group was more obvious,basically close to the normal range,the difference between the two groups was statistically significant(p<0.05),suggesting that the adaptive intervention of distant limb ischemia can effectively reduce the serum homocysteine(HCY)concentration;③ On the 14th day,the HCY concentration of the two groups continued to decrease compared with that of the 7th day which the HCY concentration of the experimental group had completely decreased to the normal range,while the HCY concentration of the control group was still higher than the normal value,and the HCY concentration between the two groups was statistically different(p<0.05);suggesting that the adaptive intervention of distant limb ischemia can accelerate the decrease of serum homocysteine(HCY)concentration compared with conventional treatment;④On the 30th day,compared with the 14th day,the serum homocysteine(HCY)concentration in the experimental group continued to decrease in the range of normal values,approaching the minimum normal value,but the control group was still higher than the normal value,and the difference of HCY concentration between the two groups was statistically significant(p<0.05),this result further indicated that the remote limb ischemia adaptive intervention could effectively reduce the serum homocysteine(HCY)concentration.⑤ The differences were statistically significant(p<0.05)among the four time period data in the experimental group and not statistically significant(p>0.05)among the four time period data in the control group,suggesting that distant limb ischemia adaptive intervention could effectively reduce serum homocysteine(HCY)concentration,while routine treatment could also reduce serum homocysteine(HCY)concentration,but the effect was not significant.[Conclusion]1.The adaptive intervention of distal limb ischemia has a good effect on improving cognitive dysfunction in patients with acute cerebral infarction,and the early effect is better than the late one.2.The acute cerebral infarction patients in the presence of cognitive dysfunction,the concentration of serum homocysteine(HCY)will be significantly increased in the early stage,the change of serum homocysteine(HCY)concentration may be one of the indicators for early judgment of cognitive dysfunction in patients with acute cerebral infarction,and further study of large samples is needed in the future.3.After the intervention of patients with acute cerebral infarction of different ages and genders,it is safe,feasible and effective to show that the adaptive intervention of distant limb ischemia has good tolerance and compliance for patients. |
