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目的观察经颅多普勒超声(TCD)联合小剂量重组组织型纤维酶原激活剂(rt-PA)治疗急性大脑中动脉闭塞性脑梗死的疗效。方法采用随机分组方法,分为2组,2组患者在溶栓前均行TCD检查确定责任血管为大脑中动脉,设TCD联合小剂量rt-PA(0.6 mg/kg,最高总剂量50 mg)静脉溶栓组30例,在溶栓开始后TCD持续监测2 h,单纯rt-PA标准剂量0.9 mg/kg(最高总剂量90 mg)溶栓组30例,仅在溶栓前行TCD监测确定责任血管为大脑中动脉;2组患者根据TCD血流速度及频谱形态判断血管再通情况,临床随访评定溶栓前后不同时间的NIHSS评分和Barthel指数。结果 TCD辅助小剂量rt-PA静脉溶栓组血管再通率为70%,明显高于对照组的30.0%,溶栓后2组NIHSS评分和Barthel指数评分存在显著差异。结论 TCD持续监测联合小剂量rt-PA静脉溶栓治疗急性脑梗死的临床疗效更佳。
Objective To observe the curative effect of transcranial Doppler ultrasonography (TCD) combined with low dose of recombinant tissue type plasminogen activator (rt-PA) on acute middle cerebral artery occlusive cerebral infarction. Methods TCD and TCD combined with low-dose rt-PA (0.6 mg / kg, the highest total dose of 50 mg) Thrombolytic group of 30 patients, TCD continued monitoring for 2 h after initiation of thrombolysis, thrombolytic group of only rt-PA standard dose of 0.9 mg / kg (maximum total dose of 90 mg) Thrombolytic group, only in the determination of TCD monitoring before thrombolysis Responsible blood vessels were middle cerebral artery. Tumor blood flow velocity and spectral shape of TCD were used to judge the situation of recanalization. The NIHSS score and Barthel index were evaluated at different time before and after thrombolysis. Results The TCD-assisted low-dose rt-PA veno-thrombolysis group had a 70% vascular recanalization rate, which was significantly higher than that of the control group (30.0%). There was significant difference between the NIHSS score and Barthel index score after thrombolysis. Conclusion TCD continuous monitoring combined with low-dose rt-PA intravenous thrombolytic therapy of acute cerebral infarction clinical efficacy is better.