Effect Of Ischemic Conditioning Therapy At Remote Limb Sites On Neurological Deficits And Cognitive Impairment In Patients With Acute Cerebral Infarction

Objective The purpose of this study was to compare the NIHSS,mRS,MOCA,and MMSE scores of the experimental and control groups by using ischemic conditioning of the remote limb site to treat patients admitted to our hospital with acute cerebral infarction,and to observe the clinical efficacy and changes in serum levels of neuron-specific enolase（NSE）and homocysteine（Hcy）in patients with acute cerebral infarction,and to explore the effectiveness and possible mechanisms of remote ischemic conditioning therapy on neurological deficits and cognitive impairment in patients with acute cerebral infarction.Methods Patients with acute cerebral infarction diagnosed and admitted to the Department of Neurology of our hospital from December 2020 to January2022 were included in this study,after screening according to the inclusion and exclusion criteria,140 patients who met the experimental requirements were finally selected and divided into 70 patients in the experimental group and 70 patients in the control group according to the random number table method,and both groups were treated according to the conventional standard basic medication of the "Guidelines for the diagnosis and treatment of acute ischemic stroke 2018",while the experimental group was given ischemic conditioning treatment in the remote part of the limb on the basis of the control group for 12±2 consecutive days,and The NIHSS,mRS,MMSE,and MOCA scores were performed on day 1 of treatment;at days12±2 of treatment,the NIHSS scores were measured and the values were recorded for both groups,and the NIHSS,mRS,MMSE,and MOCA scores were measured again at days 90±7 after discharge,and the magnitude of the scores was recorded.At the same time,serum was collected intravenously on day 1 and days 12±2 of treatment,centrifuged and sent for uniform examination,and the levels of NSE and Hcy in serum of both groups were recorded according to the test results,and the data obtained from the experiment were analyzed by applying statistical software.Result1.Comparison of the NIHSS scores between the experimental and control groups on day 1 of admission,No statistical difference（P>0.05）;NIHSS scores on day 12±2 and day 90±7 in the experimental and control groups were lower than the scores on day 1 of admission,and the differences were statistically significant（P<0.01）when compared within groups,respectively,with the NIHSS scores on day 1;comparison among groups,The NIHSS score in the experimental group was significantly lower than the NIHSS score of the control group,Comparing the NIHSS scores between the 12±2 days experimental and control groups,The difference was significant（P<0.05）,Comparison of NIHSS scores between experimental and control groups at 90±7 days,Significant statistical significance（P<0.01）.There was no significant difference in mRS score between the experimental group and the control group on the first day of admission（P>0.05）;Compared within the group,the mRS scores of the experimental group and the control group were lower than those before treatment on the90th±7th day follow-up,and the difference was statistically significant（P<0.01）;The mRS score of the experimental group was significantly lower than that of the control group at 90±7 days,the difference was statistically significant（P< 0.01）.2.The Mo CA and MMSE scores were statistically analyzed on day 1of admission for both groups,respectively,and the differences were not statistically significant（P>0.05）.The Mo CA and MMSE scores at the follow-up on days 90±7 were higher than those at day 1 in both the experimental and control groups,and the differences were statistically significant（P < 0.01）when compared within the groups;when compared between the groups,the Mo CA and MMSE scores at the follow-up on days90±7 were significantly higher in the experimental group than in the control group,and the differences were statistically significant（P< 0.01）.Meanwhile,the cognitive impairment rate of patients in the experimental group was significantly lower than that of the control group at days 90±7,and the difference was statistically significant（P < 0.05）.3.There was no statistical significance in serum NSE and Hcy levels before treatment on the first day of admission（P>0.05）.After 12±2 days of treatment,the levels of NSE and Hcy in both groups were lower than those on the first day of admission,and the differences were statistically significant（P<0.01）;After 12±2 days of treatment,the serum NSE and Hcy contents in the experimental group were significantly lower than those in the control group,and the differences were statistically significant（P<0.01）.4.During the operation,38 patients complained of pain and numbness in the compressed limbs,and 10 patients had subcutaneous ecchymosis in the compressed limbs,but all disappeared within 1 day after the end of treatment.Conclusions Ischemic adaptation therapy at distal limb sites can significantly reduce NIHSS and mRS scores,improve MMSE and MOCA scores,and significantly reduce NSE and Hcy levels in serum in patients with acute cerebral infarction,indicating that RIC therapy is more effective than conventional therapy in terms of neurological impairment,prognosis and cognitive recovery after acute cerebral infarction.The possible cerebral protection mechanism is related to reducing blood-brain barrier damage and its permeability,decreasing atherosclerosis and reducing endothelial damage.And the method is simple,safe,reliable and easy to operate.