Effects of Remote Ischemic Preconditioning on Biochemical Markers and Neurologic Outcomes in Patients Undergoing Elective Cervical Decompression Surgery A Prospective Randomized Controlled Trial
Effects of Remote Ischemic Preconditioning on Biochemical Markers and Neurologic Outcomes in Patients Undergoing Elective Cervical Decompression Surgery A Prospective Randomized Controlled Trial
复制标题
远程缺血预处理对择期颈椎减压手术患者生化标志物和神经系统结果的影响一项前瞻性随机对照试验
DOI：
10.1097/ana.0b013e3181c572bd
复制
发表时间：
2010-01-01
影响因子：
3.7
通讯作者：
Xiong, Lize
中科院分区：
文献类型：
--
作者：
Hu, Sheng;Dong, Hai-long;Xiong, Lize
背景：远程缺血预处理（RIPC）对脊髓缺血性损伤具有保护作用。这项随机临床试验旨在评估是否需要进行一项大型临床试验，以测试RIPC对接受脊柱手术的患者神经功能结局的影响。ClinicalTrial.gov方法：将40例择期行脊髓型颈椎病减压手术的患者随机分为RIPC组和对照组，每组20例。肢体RIPC包括三个5分钟循环的右上肢体缺血，中间有5分钟的再灌注期。在设定的时间点测量血清中神经元特异性烯醇化酶和S-100 B水平。正中神经体感诱发电位（SEP）也被记录。结果：RIPC能显著降低术后6 h和1 d血清S-100 B的释放，并能显著降低术后6 h、1、3、5 d血清神经元特异性烯醇化酶的释放。在对照组和RIPC组之间，没有观察到SEP测量值或术中SEP变化的发生率存在差异。RIPC组术后7天、1个月和3个月的恢复率高于对照组（P < 0.05）。我们对神经元缺血性损伤标志物和恢复率的研究结果表明，一项具有足够统计学把握度的临床试验可以检测RIPC对神经系统并发症发生率的影响。（轻瘫、麻痹等）。
Background: Remote ischemic preconditioning (RIPC) may protect the spinal cord from ischemic injury. This randomized clinical trial was designed to assess whether a large clinical trial testing the effect of RIPC on neurologic outcome in patients undergoing spine Surgery is warranted. This trial was registered with ClinicalTrial.gov, number NCT00778323.Methods: Forty adult cervical spondylotic myelopathy patients undergoing elective decompression surgery were randomly assigned to either the RIPC group (n = 20) or the control group (n = 20). Limb RIPC consisted of three 5-minute cycles of upper right limb ischemia with intervening 5-minute periods of reperfusion. Neuron-specific enolase and S-100B levels were measured in serum at set time points. Median nerve somatosensory-evoked potentials (SEPs) were also recorded. Neurologic recovery rate was evaluated using a Japanese Orthopaedic Association scale.Results: RIPC significantly reduced serum S-100B release at 6 hours and I day after surgery, and reduced neuron-specific enolase release at 6 hours, and then at 1, 3, and 5 days after surgery. No differences were observed in SEP measurements or the incidence of SEP changes during surgery between the control and RIPC groups. Recovery rate at 7 days, and at I and 3 months after surgery was higher in the RIPC group than in the control group (P < 0.05).Conclusions: Our results for markers of neuronal ischemic injury and rate of recovery suggest that a clinical trial with sufficient statistical power to detect an effect of RIPC on the incidence of neurologic complications (paresis, palsy, etc) due to spinal cord ischemia-reperfusion injury after spine surgery.