Remote ischemic conditioning (RIC) with exercise (RICE) is safe and feasible for acute ischemic stroke (AIS) patients.
Remote ischemic conditioning (RIC) with exercise (RICE) is safe and feasible for acute ischemic stroke (AIS) patients.
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远程缺血调理（RIC）加运动（RICE）对于急性缺血性卒中（AIS）患者来说是安全可行的
DOI：
10.3389/fneur.2022.981498
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发表时间：
2022
影响因子：
3.4
通讯作者：
中科院分区：
文献类型：
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作者：
康复对于减少中风残疾至关重要，应尽早进行。运动是一种公认的有效的康复方法，但由于其早期使用会加重脑损伤，并受到患者病情不稳定和残疾的限制，因此其实施受到限制。远程缺血预处理（RIC）是一种被动和可访问的治疗急性期中风，似乎有类似的神经保护作用的运动。本研究旨在评估急性缺血性脑卒中（AIS）患者早期RIC后运动（RICE）这一新型康复策略的安全性和可行性。我们对卒中发作或症状加重24小时内的AIS患者进行了一项单中心、双盲、随机对照试验。所有入选的患者以1：1的比例随机分配到RICE组或假RICE组（假RIC加运动）。每组在卒中发作或症状加重后24 h内接受RIC或假RIC，每天一次，共14天。两组均在第4天开始锻炼，每天两次，共11天。安全性终点包括住院期间RICE导致的临床恶化、卒中复发、出血性转化、并发症和不良事件。在入院时和卒中发作后90天评价疗效终点[改良兰金量表（mRS）评分、美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数和步行能力]。招募了40名AIS患者并完成了研究。两组患者的基线特征无显著差异，包括危险因素、入院时卒中严重程度、病前残疾和其他特殊治疗。两组安全性终点无显著差异。术后3个月时，RICE组55%的患者恢复良好（mRS 0-2），而假手术组40%的患者恢复良好，但未达到显著水平。RICE对AIS患者安全可行，是一种有前途的早期脑卒中康复治疗方法。这项研究的结果表明，未来需要一个更大样本量的随机对照多中心试验来确定RICE的疗效。
Rehabilitation is essential in reducing stroke disability and should be performed as early as possible. Exercise is an established and effective rehabilitation method; however, its implementation has been limited as its very early use exacerbates cerebral injury and is restricted by patients' unstable conditions and disabilities. Remote ischemic conditioning (RIC) is a passive and accessible therapy in acute phases of stroke and appears to have similar neuroprotective effects as exercise. This study assessed the safety and feasibility of the novel rehabilitation strategy—early RIC followed by exercise (RICE) in acute ischemic stroke (AIS). We conducted a single-center, double-blinded, randomized controlled trial with AIS patients within 24 h of stroke onset or symptom exacerbation. All enrolled patients were randomly assigned, at a ratio of 1:1, to either the RICE group or the sham-RICE group (sham RIC with exercise). Each group received either RIC or sham RIC within 24 h after stroke onset or symptom exacerbation, once a day, for 14 days. Both groups started the exercise routine on day 4, twice daily, for 11 total days. The safety endpoints included clinical deterioration, recurrence of stroke, hemorrhagic transformation, complications, and adverse events resulting from RICE during hospitalization. The efficacy endpoints [Modified Rankin Scale (mRS) score, National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index, and walking ability] were evaluated at admission and 90 days after stroke onset. Forty AIS patients were recruited and completed the study. No significant differences in baseline characteristics were found between the two groups, which included risk factors, stroke severity at admission, pre-morbid disability, and other special treatments. No significant differences were found in the safety endpoints between two groups. Excellent recovery (mRS 0–2) at 3 months was obtained in 55% of the patients with RICE as compared 40% in sham group, but it did not reach a significant level. RICE was safe and feasible for AIS patients, and seems to be a promising early stroke rehabilitation. The results of this study suggest a need for a future randomized and controlled multicenter trial with a larger sample size to determine the efficacy of RICE.