目的 对比磁敏感加权成像（SWI）、磁共振成像（MRI）、第3代双源电子计算机断层扫描（CT）三种方式在急性缺血性脑卒中（AIS）患者血管内治疗后诊断出血灶以及碘对比剂外渗中的临床价值。方法 选取2022年1月—2023年2月在新乡医学院第一附属医院接受血管内治疗的80例AIS患者作为研究对象,所有患者均接受MRI、SWI、第3代双源CT检查,经综合分析后确定诊断结果,对比三种检查方法对治疗后早期出血灶的鉴别效能,同时以治疗72 h后的常规CT结果作为诊断金标准,评价三种检查方法诊断早期出血灶与碘对比剂外渗的效能。结果 MRI的阳性预测价值为90.32%、阴性预测价值为88.00%,SWI的阳性预测价值为93.55%、阴性预测价值为92.00%,第3代双源CT的阳性预测价值为93.75%、阴性预测价值为95.83%,其中第3代双源CT与金标准的一致性更高（Kappa=0.891）。与治疗72 h后的常规CT结果对比,MRI的曲线下面积（AUC）为0.907,诊断灵敏度为90.32%、特异度为88.00%、准确度为89.29%;SWI的AUC为0.937,诊断灵敏度为93.55%、特异度为92.00%、准确度为92.86%;第3代双源CT的AUC为0.971,诊断灵敏度为96.77%、特异度为92.00%、准确度为94.64%,第3代双源CT的诊断效能最高。结论 AIS血管内治疗后,采用SWI、MRI、第3代双源CT三种检查方式均能有效区分出血灶与碘对比剂外渗情况,且临床诊断价值较好。

李俊,广东省名中医,从事中医临床工作30年,尤擅长经方“峻剂轻投”治疗疑难杂症,主张根据病情需要,从小剂量用起;根据脾胃功能,以小剂量取效;根据慢性病的特点,以小剂量调治;根据个体差异,以小剂量获效;并注重杂合以治疗。

目的 探讨脑卒中患者多重耐药菌（MDROs）医院感染风险因素,并进行病原学特点分析。方法 选择2020年1月—2022年12月福建中医药大学附属福鼎医院神经内科病房收治的160例脑卒中患者为研究对象,评估患者的MDROs医院感染发生状况,调查患者的一般资料并进行多因素分析。结果 在160例患者中,发生医院感染20例,分离到病原体26株,其中8例样本为MDROs（研究组,其他归为对照组）,来源于8例患者,占比5.00%,包括耐甲氧西林金黄色葡萄球菌（MRSA）3株,耐碳青霉烯大肠埃希菌（E.coli）2株、耐碳青霉烯肺炎克雷伯菌（KP）1株、全耐药KP1株、耐碳青霉烯PA1株。研究组的美国国立卫生院神经功能缺损（NIHSS）评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、糖尿病、低蛋白血症、置管留置时间、住院时间等与对照组对比差异有统计学意义（P<0.05）。二分类Logistic回归分析显示,上述指标均为导致MDROs医院感染发生的重要因素（P<0.05）。结论 脑卒中患者MDROs医院感染的发生率依然比较高,病原菌多为耐甲氧西林MRSA、耐碳青霉烯E.coli,患者的NIHSS评分、APACHEⅡ评分、糖尿病、低蛋白血症、置管留置时间、住院时间为主要的MDROs感染风险因素。

目的 探讨柚皮素对人乳腺癌细胞株MCF-7和小鼠乳腺癌细胞系4T1的作用机制。方法 选择人乳腺癌细胞株MCF-7和小鼠乳腺癌细胞系4T1为实验对象,设置对照组和柚皮素组,其中柚皮素组分为20、40、80 和120 μmol/L 4个浓度,利用CCK-8、平板克隆形成实验检测柚皮素对乳腺癌细胞的增殖作用,应用流式细胞术检测柚皮素对乳腺癌细胞的凋亡作用。建立乳腺癌移植瘤模型,应用柚皮素作用于模型小鼠,探讨柚皮素在体内抗肿瘤作用。通过荧光定量PCR和蛋白免疫印迹实验检测自噬相关基因,分析其作用机制。结果 经柚皮素处理后,乳腺癌细胞的增殖明显受到抑制,正常乳腺癌细胞增殖情况变化不大,MCF-7乳腺癌细胞和小鼠乳腺癌4T1均出现明显的凋亡（P<0.001）。结论 柚皮素可以抑制乳腺癌细胞的增殖,且对正常乳腺细胞无明显毒副作用。柚皮素通过凋亡和自噬方式促进乳腺癌细胞的死亡,体内实验结果显示柚皮素具有抗肿瘤作用,并可促进其坏死。

目的 观察伊伐布雷定对冠状动脉粥样硬化性心脏病（CHD,以下简称：冠心病）合并心律失常患者心率变异性（HRV）的影响,及对心房颤动（AF）的防治效果。方法 本文为前瞻性研究,病例纳入时间为2021年1月—2023年1月,研究对象为焦作市第二人民医院收治的125例CHD合并心律失常患者,采用随机数字表法对入组患者进行分组,分别列为常规组（62例）和联合组（63例）,常规组予常规药物治疗,联合组在常规药物治疗基础上联合伊伐布雷定治疗,比较2组患者治疗前后的HRV指标、血管内皮功能指标、心功能指标改善情况、心房颤动发生率及用药安全性。结果 治疗后,联合组24 h窦性心律RR间期标准差为（88.25±10.36）ms,24 h相邻正常RR间期差值均方根为（50.25±10.61）ms,24 h相邻正常RR间期差值>50 ms百分比为（12.04±3.41）%,均高于常规组[（81.44±10.77）ms、（43.28±10.71）ms、（10.77±3.08）%],组间比较差异具有统计学意义（P<0.05）。治疗后,联合组的血流介导下血管扩张程度为（12.33±3.27）%,硝酸甘油介导下血管内皮舒张程度为（9.83±2.21）%,均高于常规组[（10.25±3.23）%、（8.14±2.03）%]。AF发生率为4.76%（3/63）,低于常规组16.13%（10/62）,差异具有统计学意义（P<0.05）。治疗后,联合组的左室射血分数为（55.35±10.27）%,高于常规组（48.45±10.61）%,左室舒张末期内径为（40.24±10.37）mm,左室后壁厚度为（9.22±2.06）mm,均低于常规组[（46.33±10.28）mm、（10.88±2.46）mm],差异具有统计学意义（P<0.05）。治疗后,联合组的药物相关不良反应发生率为7.94%（5/63）,略高于常规组6.45%（4/62）,组间比较差异无统计学意义（P>0.05）。结论 伊伐布雷定联合常规药物治疗CHD合并心律失常能有效改善患者HRV指标、血管内皮功能及心功能,降低AF发生率,且未增加药物不良反应发生风险。

Objective To observe the effect of ivabradine on heart rate variability（HRV）in coronary heart disease（CHD）patients with arrhythmia and its preventive and therapeutic effects on atrial fibrillation（AF）．Methods This is a prospective cohort study．The 125 CHD patients with arrhythmia were included from January 2021 to January 2023 and divided into the conventional group（62 cases）and the combined group（63 cases）by random number table．The conventional group was treated with conventional drugs,and the combined group was treated with ivabradine additionally．The HRV index,vascular endothelial function index,improvement of cardiac function indicators,incidence of AF and medication safety were compared．Results After treatment,the standard deviation of normal RR intervals in 24 h of the combination group was（88.25±10.36）ms,root mean square of successive RR interval differences in 24 h was（50.25±10.61）ms,and successive RR interval differences>50 ms was（12.04±3.41）%．Compared with the conventional group [（81.44±10.77）ms,（43.28±10.71）ms and（10.77±3.08）%],the above indicators were all higher（P<0.05）．After treatment,the flow-mediated dilation and nitrite-mediated dilation of the combination group were（12.33±3.27）% and（9.83±2.21）%,respectively．Compared with the conventional group（10.25±3.23）% and（8.14±2.03）%）,the above indicators were higher．The incidence of AF was 4.76%（3/63）,which was lower（P<0.05）than the conventional group of 16.13%（10/62）．After treatment,the left ventricular ejection fraction of the combination group was（55.35±10.27）%,which was higher than that of the conventional group（48.45±10.61）%．The left ventricular diastolic diameter was（40.24±10.37）mm and the left ventricular posterior wall thickness was（9.22±2.06）mm．Compared with the conventional group [（46.33±10.28）mm,（10.88±2.46）mm],the above indicators were all lower（P<0.05）．After treatment,the incidence of drug-related side effects in the combination group was 7.94%（5/63）,which was similar to 6.45%（4/62）in the conventional group（P>0.05）．Conclusions The combination of ivabradine and conventional drugs in the treatment of CHD complicated with arrhythmia can effectively improve HRV indicators in patients,promote the recovery of vascular endothelial cell function and cardiac function,reduce the incidence of AF,and do not significantly increase the risk of drug side effects．

目的 观察脑性瘫痪（CP）伴营养不良患儿进行系统性饮食调整的效果。方法 2015年1月—2022年1月我院收治以CP伴营养不良患儿80例,以随机数字表法分为对照组和研究组各40例,常规护理指导用于对照组,系统性饮食调整护理用于研究组。比较2组患儿在干预前、后的生化指标（白蛋白、血红蛋白、肌酐、低密度脂蛋白水平）、身体指标（体质量、身高、体质指数、腹部皮下脂肪厚度）、肠内营养混悬液使用剂量及饮食行为能力评分和患儿监护人对干预的满意率。结果 干预后2组的生化指标可见明显变化,其中研究组与对照组相比,白蛋白、血红蛋白、肌酐指标提升更多更平稳,而低密度脂蛋白研究组较对照组相比,降低更多更平稳,（P<0.01）。在干预后两组间的身体指标可见明显变化,其中研究组与对照组相比,体质量、体质指数、腹部皮下脂肪厚度较干预前增加更多更平稳,而低密度脂蛋白研究组较对照组相比,降低更多更平稳,（P<0.01）。在干预后2组的肠内营养混悬液使用剂量及饮食行为能力评分较干预前可见明显变化,其中研究组与对照组相比,肠内营养混悬液使用剂量及饮食行为能力降低更多更平稳（均P<0.05）。研究组监护人对干预的满意率高于对照组（P<0.05）。结论 在CP伴营养不良患儿中,开展有效的系统性饮食调整干预,可有效改善患儿的生化指标,提升各项身体指标,减少肠内营养混悬液的使用剂量,改善饮食行为能力,获得患儿监护人的认可,效果理想。

Objective To observe the effect of systematic diet adjustment in children with cerebral palsy（CP）and malnutrition．Methods A total of 80 CP children with malnutrition treated in our hospital（from January 2015 to January 2022）were divided into two groups by random number table method．Control group received routine nursing guidance and study group received systematic diet adjustment nursing．The biochemical indexes（albumin,hemoglobin,creatinine,low-density lipoprotein levels）,physical indexes（weight,height,body mass index,abdominal subcutaneous fat thickness）,the dosage of enteral nutritional suspension and the score of dietary behavior ability were compared between the two groups before and after the intervention．The satisfaction rate of the children's families with the intervention was evaluated．Results After the intervention,the biochemical indexes of the two groups showed significant changes．Compared with the control group,the indexes of albumin,hemoglobin and creatinine in the study group increased more and more stably,while the index of low-density lipoprotein in the study group decreased more and more stably（P<0.01）．After the intervention,the physical indexes of the two groups showed significant changes．Compared with the control group,the weight,body mass index and abdominal subcutaneous fat thickness of the study group increased more and more stably than before the intervention,while the low-density lipoprotein study group decreased more and more stably（P<0.01）．After the intervention,the dosage of enteral nutritional suspension and the score of dietary behavior ability in the two groups showed significant changes compared with those before the intervention．Compared with the control group,the immune indexes in the study group increased more and more stably,while the dosage of enteral nutritional suspension and the score of dietary behavior ability in the study group decreased more and more stably（P<0.05）．The satisfaction rate of family members in the study group was higher than that in the control group（P<0.05）．Conclusions In children with CP and malnutrition,carrying out effective systematic diet adjustment intervention can significantly improve the biochemical indexes of children,improve various physical indexes,improve immune ability,reduce the dosage of enteral nutritional suspension,improve dietary behavior,and obtain the recognition of children's family members,which has ideal effects．

目的 探讨外周血CD34阳性（CD34⁺）细胞计数对普乐沙福自体干细胞动员效果的预测价值。方法 回顾性分析2021年5月—2023年7月中山大学附属第七医院使用人粒细胞集落刺激因子（G-CSF）联合普乐沙福进行自体干细胞动员的13例患者临床资料,分析普乐沙福动员前后外周血CD34⁺细胞计数的变化及干细胞采集情况。结果 共有13例患者纳入研究,包括淋巴瘤10例和多发性骨髓瘤3例。多发性骨髓瘤患者中1例为新诊断,另2例为复发患者;淋巴瘤患者中3例为套细胞淋巴瘤,6例为弥漫大B细胞淋巴瘤（包括1例复发）,1例为B细胞淋巴瘤（不能明确类型）。本研究纳入的患者均使用G-CSF动员,在使用普乐沙福后CD34⁺细胞计数均升高,使用普乐沙福前中位CD34⁺细胞计数为13.3（2.5~76.1）/μL,使用普乐沙福后中位CD34⁺细胞计数为73.6（10.4~208.70）/μL,升高4.18（1.99~13.60）倍。13例患者中有2例患者在使用普乐沙福前外周血CD34⁺细胞计数<5 /μL,均动员失败。Spearman相关分析结果显示,使用普乐沙福后CD34⁺细胞计数与使用普乐沙福前CD34⁺细胞数呈正相关（r_s=0.769,P=0.003）。多元线性回归分析显示,使用普乐沙福后CD34⁺细胞计数能较好地预测采集结果（P=0.004）。结论 监测外周血CD34⁺细胞计数可预测普乐沙福自体干细胞动员效果,使用普乐沙福后CD34⁺细胞计数越多,CD34⁺细胞采集量越大。

Objective To explore the predictive value of peripheral blood CD34⁺ cell count for the stem cell mobilization effect of plerixafor．Methods The clinical data of 13 patients who used granulocyte colony-stimulating factor + plerixafor for stem cell mobilization in the Seventh Affiliated Hospital of Sun Yat-sen University from May 2021 to July 2023 were retrospectively analyzed．The changes of peripheral blood CD34⁺ cell count in all patients before and after the mobilization of plerixafor were analyzed．Results In 13 enrolled patients,there were 10 lymphoma patients and 3 multiple myeloma（MM）patients．One patient was newly diagnosed with MM,and the other two were recurrent patients．The lymphoma cases included 3 mantle cell lymphoma,6 diffuse large B cell lymphoma and 1 B cell non-Hodgkin's lymphoma（type cannot be specified）．The CD34⁺ cell counts were increased in all patients when mobilized with granulocyte colony-stimulating factor before plerixafor．The CD34⁺ cell count was 13.3（2.5~76.1）/μL and 73.6（10.4~208.70）/μL before and after the use of plerixafor,between which the difference was statistically significant（Z=0.578,P<0.05）,and the median increased of 4.18（1.99~13.6）times．There were 2 patients failed in mobilizing whose CD34⁺ cell count was less than 5 /μL before using plerixafor．Spearman analysis showed that there was a positive correlation in peripheral blood CD34⁺ cell count before and after the use of plerixafor（r_s=0.80,P=0.032）．The CD34⁺ cell count after using plerixafor was a good predictor of the collection results（P=0.002）．Conclusions Monitoring the CD34⁺ cell count in peripheral blood has a certain predictive value for the stem cell mobilization effect of plerixafor．The higher of CD34⁺ cell count after the use of plerixafor,the higher of CD34⁺ collection．

目的 观察程序性死亡受体1（PD-1）联合细胞毒性T淋巴细胞相关蛋白4（CTLA-4）双免疫疗法对改善晚期乳腺癌近期疗效及远期预后的影响。方法 选择2020年5月—2022年5月商丘市第一人民医院收治的124例晚期乳腺癌患者为研究对象,经随机数字表法将其分为对照组（60例）和观察组（64例）,对照组予以常规PD-1单抗免疫疗法治疗,观察组采用PD-1联合CTLA-4双免疫疗法治疗,比较2组患者治疗前后肿瘤标志物水平、治疗后病灶缓解情况,对所有患者开展为期1年随访,统计并对比2组的不良反应发生情况及远期生存情况。结果 治疗前,2组患者的肿瘤标志物水平比较差异均无统计学意义（均P>0.05）;治疗后,观察组的癌胚抗原为（3.36±0.17）ng/mL,糖类抗原15-3为（25.33±5.28）U/mL,糖类抗原19-9为（38.77±5.62）U/mL,均低于对照组[（5.27±1.36）ng/mL、（28.44±5.18）U/mL、（41.25±5.46）U/mL,均P<0.05]。治疗后,观察组的完全缓解率为21.88%（14/64）,部分缓解率为31.25%（20/64）,病情稳定率为37.50%（24/64）,均高于对照组[8.33%（5/60）、13.33%（8/60）、23.33%（14/60）],肿瘤生长率为（30.27±5.18）%,肿瘤超进展率为6.25%（4/64）,均低于对照组[（33.49±5.32）%、18.33%（11/60）,均P<0.05]。治疗后,观察组的不良反应发生率为34.38%（22/64）,略高于对照组33.33%（20/60）,组间比较差异无统计学意义（P>0.05）;观察组的中位无进展生存期为（9.33±2.25）月,中位总生存期为（10.76±3.32）月,均高于对照组[（7.25±2.31）月、（7.41±1.62）月,均P<0.05]。结论 PD-1联合CTLA-4双免疫疗法能有效改善晚期乳腺癌的近期疗效及远期预后,此疗法未明显增加不良反应发生风险,安全性高。

Objective To observe the effect of programmed cell death protein-1（PD-1）combined with cytotoxic T lymphocyte-associated antigen-4（CTLA-4）dual immunotherapy on the short-term efficacy and long-term prognosis of advanced breast cancer．Methods A total of 124 patients with advanced breast cancer who were admitted to the First People's Hospital of Shangqiu City from May 2020 to May 2022 were selected as the research objects．They were randomly divided into the control group（60 cases）and the observation group（64 cases）by the method of random number table．The control group was treated with conventional PD-1 monoclonal antibody immunotherapy,and the observation group was treated with PD-1 combined with CTLA-4 double immunotherapy．The levels of tumor markers before and after treatment and the focal remission after treatment were compared between the two groups．All patients were followed up for one year,the incidence of adverse reactions and long-term survival between the two groups were compared．Results Before treatment,there was no statistically significant difference in the levels of tumor markers between two groups（all P>0.05）．After treatment,the carcino-embryonic antigen content of the observation group was（3.36±0.17）ng/mL,CA153 was（25.33±5.28）U/mL,and CA199 was（38.77±5.62）U/mL,which were lower than those of the control group [（5.27±1.36）ng/mL,（28.44±5.18）U/mL,（41.25±5.46）U/mL,all P<0.05]．After treatment,the complete remission rate of the observation group was 21.88%（14/64）,partial remission rate was 31.25%（20/64）,and stable disease rate was 37.50%（24/64）,all higher than those of the control group [8.33%（5/60）,13.33%（8/60）,23.33%（14/60）];tumor growth rate of the observation group was（30.27±5.18）%,hyper progressive disease rate was 6.25%（4/64）,both lower than those of the control group [（33.49±5.32）%,18.33%（11/60）,both P<0.05]．After treatment,the incidence of adverse reactions in the observation group was 34.38%（22/64）,slightly higher than that in the control group 33.33%（20/60）（P>0.05）．The median progression free survival of the observation group was（9.33±2.25）months,and the median overall survival was（10.76±3.32）months,both higher than those of the control group [（7.25±2.31）months and（7.41±1.62）months]（P<0.05）．Conclusions PD-1 combined with CTLA-4 dual immunotherapy can effectively improve the short-term efficacy and long-term prognosis of advanced breast cancer．This therapy does not significantly increase the risk of side effects,which is safe．

目的 观察改良直接抽吸取栓术（ADAPT）治疗急性前循环大动脉栓塞性脑卒中的有效性与安全性。方法 回顾性分析2022年3月—2023年2月在广州市第一人民医院采用改良ADAPT治疗急性前循环大动脉栓塞性脑卒中的12例患者临床资料。该改良技术核心是血栓抽吸导管或颅内支持导管管头明确越过血栓后才开始直接使用20 mL的注射器进行手动持续抽吸;所有患者术后依据临床症状和影像表现启动规范抗凝药物治疗,每月门诊随访观察有无再发卒中。结果 12例患者闭塞血管均成功再通,其中改良脑梗死溶栓（mTICI ）2b~2c级3例（25%）,mTICI 3级9例（75%）;从穿刺到血管再通平均时间为37.7 min,首次取栓再通8例（66.7%）,其中颈内动脉闭塞首次取栓再通成功率达80%,出院时平均美国国立卫生研究院卒中量表（NIHSS）评分（9.00±9.22）分,与术前基础NIHSS评分相比,平均下降7分,术后90 d功能恢复良好（mRS评分0~2分）9例（75%）;术后脑出血3例（25%）,其中1例为小点状出血（HI1）而无明显症状、1例为血肿<梗死面积的30%并有轻微占位效应的出血（PH1）恢复良好、1例为血肿>梗死面积的30%并有明显占位效应的出血（PH2）术后自动出院,12例患者筛查病因均发现有心房纤颤,9例患者术后依据临床症状和影像表现在早期开展规范抗凝二级预防管理后无再复发。结论 改良ADAPT是治疗急性大动脉栓塞性脑卒中的一种安全可行选择,血管再通效率高,血栓逃逸概率低、临床疗效良好。对心房纤颤患者实施规范抗凝管理可有效预防脑卒中复发。

Objective To observe the efficacy and safety of modified-a direct aspiration first-pass technique（ADAPT）in the treatment of acute anterior circulation aorta embolic stroke．Methods The clinical data of 12 patients with acute anterior circulation arterial embolic stroke treated by modified-ADAPT in our hospital from March 2022 to February 2023 were analyzed retrospectively．The core of the modified technique is that the head of the thrombus aspiration catheter or intracranial support catheter clearly crosses the thrombus before manual continuous suction with a 20 mL syringe．After operation,all patients started standard anticoagulant therapy according to clinical symptoms and imaging manifestations,and monthly outpatient follow-up was conducted to observe whether there was recurrent stroke．Results Occlusive vessels were successfully recanalized in 12 patients,including 3 cases（25%）of mTICI 2b-2c grade and 9 cases（75%）of mTICI 3 grade．The average time from puncture to vascular recanalization was 37.7 min,and the first thrombectomy and recanalization was performed in 8 cases（66.7%）．The success rate of internal carotid artery occlusion was 80%．The average NIHSSS score at discharge was（9.00±9.22）．Compared with the preoperative NIHSS score,the average score decreased by 7 points．90 days after operation,the function recovered well in 9 cases（75%）．Postoperative cerebral hemorrhage occurred in 3 cases（25%）,including 1 case of punctate hemorrhage without obvious symptoms,1 case of good recovery of PH1 and 1 case of automatic discharge after PH2．12 patients were found to have atrial fibrillation after screening,9 patients had no recurrence after anticoagulation secondary prevention management according to clinical symptoms and imaging manifestations．Conclusions Modified-ADAPT is a safe and feasible choice for the treatment of acute arterial embolism stroke,with high recanalization efficiency,low thrombus escape probability and good clinical effect．Standardized anticoagulation management can effectively prevent the recurrence of stroke in patients with atrial fibrillation．

目的 对比颈动脉内膜剥脱术（CEA）不同时间预处理对患者术后应激反应及神经功能的影响。方法 回顾性收集2019年12月—2022年12月在我院择期行CEA术治疗的74例颈动脉狭窄（CS）患者临床资料,按远隔缺血预处理（RIPC）时间不同分成2组,其中A组37例（术前1 h进行预处理）、B组37例（术前24 h进行预处理）。对比2组术前1 d、麻醉诱导后、切皮时交感神经反应指标[收缩压（SBP）、心率（HR）、舒张压（DBP）]变化及手术前后简易精神状态评价量表（MMSE）评分、应激指标[去甲肾上腺素（NE）、白细胞介素-6（IL-6）、皮质醇（Cor）]、神经功能指标[脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S-100β）]水平。结果 与A组相比,麻醉诱导后B组SBP、HR、DBP水平更高,切皮时SBP、HR、DBP水平更低（P<0.05）;与A组相比,B组术后7 d、30 d MMSE评分更高（P<0.05）;术后12 h、24 h 2组血清NE、Cor、IL-6水平均较术前1 d升高（P<0.05）,但2组比较差异无统计学意义（P>0.05）;与A组相比,B组术后12 h、24 h血清S-100β、NSE水平更低,血清BDNF水平更高（P<0.05）。结论 CEA术前实施RIPC可减轻脑损伤,发挥脑保护作用,但与术前1 h实施RIPC相比,于术前24 h实施RIPC更有助于维持机体血流动力学稳定,促进认知功能及预后恢复。

Objective To compare the effects of different time preconditioning of carotid endarterectomy（CEA）on postoperative stress response and neurological function．Methods From December 2019 to December 2022,74 patients with carotid stenosis（CS）who were selected for CEA treatment in our hospital were retrospectively collected and divided into two groups according to the time of remote ischemic preconditioning（RIPC）,including 37 cases in group A（preconditioning at 1 hour before surgery）and 37 cases in group B（preconditioning at 24 hours before surgery）．The changes of sympathetic response indexes [systolic blood pressure（SBP）,heart rate（HR）,diastolic blood pressure（DBP）] in the 2 groups at 1 d before surgery,after the anesthesia induction,and at the time of skin incision before and after surgery,and the scores of the Mini-Mental State Examination（MMSE）,stress indexes [norepinephrine（NE）,interleukin-6（IL-6）,cortisol（Cor）],and neurological function indexes [brain-derived neurotrophic factor（BDNF）,neuron specific enolase（NSE）,central nervous specific protein（S-100β）]．Results Compared with group A,the levels of SBP,HR and DBP in group B after anesthesia induction were higher,and the levels of SBP,HR and DBP were lower during skin resection（P<0.05）．Compared with group A,group B had higher MMSE scores at 7 and 30 days after surgery（P<0.05）．The serum levels of NE,Cor and IL-6 in the 2 groups were increased 12 h and 24 h after surgery compared with 1 day before surgery（P<0.05）,but there was no significant difference between the 2 groups（P>0.05）．Compared with group A,serum S-100β and NSE levels in group B were lower at 12 h and 24 h after surgery,and serum BDNF level was higher in group B（P<0.05）．Conclusions The administration of RIPC before CEA can reduce brain injury and play a protective role in brain．However,compared with the administration of RIPC 1 h before surgery,the administration of RIPC 24 h before surgery is more conducive to maintaining hemodynamic stability,promoting cognitive function and prognostic recovery．