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目的探讨定量脑电图(QEEG)是否对重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓疗效具有预测价值。方法选择76例发病在4.5 h内的脑梗死患者,其中男性39例,女性37例;年龄51~79岁,平均年龄60.0岁。使用rt-PA静脉溶栓治疗,并且对这些患者分别在溶栓前和溶栓后2 h、24 h、7 d、14 d、90 d进行QEEG观察评估及美国国立卫生研究院卒中量表(NIHSS)评分。观察各时间点脑电图的指标大脑对称指数(BSI)、δ+θ波与α+β波的比率(DTABR)的变化。根据NIHSS评分的变化将溶栓治疗的患者分为早期有效组及无效组,NIHSS评分在14 d时间点改善者归为改善组,未改善者归为未改善组。结果两组NIHSS评分变化:两组7 d NIHSS评分差异具有显著统计学意义,改善组优于未改善组,重要的是改善组NIHSS评分在7 d时间点已经较24 h明显改善,而未改善组无改善(P<0.01);90 d NIHSS评分差异具有显著统计学意义,改善组优于未改善组(P<0.01)。两组脑电图变化:在改善组,脑电图BSI的改善从24 h开始,DTABR从7 d开始(P<0.01);在未改善组,BIS和DTABR均从24 h开始恶化,BIS从7 d开始改善,DTABR从14 d开始改善。溶栓治疗有效的患者NIHSS评分从7 d开始明显改善,持续缓解至90 d。rt-PA静脉溶栓NIHSS评分改善越早,90 d预后越好。脑电图BSI及DTABR改善越早NIHSS评分改善越早;BSI及DTABR早期恶化的NIHSS评分改善越晚。结论在评估脑功能改善方面,BSI灵敏度优于DTABR和NIHSS。QEEG指标以BSI改善较早,它可以用于早期脑梗死患者rt-PA静脉溶栓疗效敏感的预测;BSI和DTABR早期恶化可以用于早期脑梗死患者rt-PA静脉溶栓疗效不佳的预测。
Objective To investigate whether quantitative electroencephalogram (QEEG) has predictive value for intravenous thrombolytic therapy of recombinant tissue plasminogen activator (rt-PA). Methods A total of 76 patients with cerebral infarction within 4.5 hours were selected, including 39 males and 37 females. The patients were 51 to 79 years old with an average age of 60.0 years. The patients were treated with intravenous thrombolytic therapy of rt-PA, QEEG assessment of these patients before and after thrombolysis at 2 h, 24 h, 7 d, 14 d and 90 d, and the National Institutes of Health Stroke Scale NIHSS) score. The changes of the index of brain EEG (BSI), the ratio of δ + θ wave to α + β wave (DTABR) were observed at different time points. According to the change of NIHSS score, the thrombolytic therapy patients were divided into the early effective group and the invalid group. The NIHSS score was improved in the 14th day, and the non-improvement was classified as the unimproved group. Results NIHSS score changes between the two groups: NIHSS score differences between the two groups on the 7th day was statistically significant, improvement group was better than the unimproved group, it is important to improve the NIHSS score group at 7 d time point has significantly improved compared with 24 h, without improvement (P <0.01). The difference of NIHSS score at 90 d was statistically significant, and the improvement group was better than the non-improvement group (P <0.01). EEG changes of the two groups: in the improvement group, the improvement of BSI in EEG started from 24 h, DTABR started from 7 d (P <0.01); in non-improvement group, BIS and DTABR started to deteriorate from 24 h, BIS from 7 d began to improve, DTABR improved from 14 d. The NIHSS scores of patients with thrombolytic therapy were significantly improved from 7 days and continued to be reduced to 90 days. rt-PA intravenous thrombolysis NIHSS score to improve the earlier 90d the better the prognosis. The earlier the improvement of EEG BSI and DTABR, the earlier the improvement of NIHSS score; the later the improvement of NIHSS score of early deterioration of BSI and DTABR. Conclusions BSI is superior to DTABR and NIHSS in assessing brain function improvement. The QEEG index improves earlier with BSI and can be used to predict rt-PA thrombolytic response in patients with early cerebral infarction. Early worsening of BSI and DTABR can be used to predict poor outcome of rt-PA thrombolysis in patients with early cerebral infarction .