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目的探讨影像指导下醒后脑梗死(WUIS)患者阿替普酶静脉溶栓治疗的效果。方法 209例阿替普酶静脉溶栓治疗的脑梗死患者的临床资料,分为发病时间4.5 h内溶栓患者(标准溶栓组163例)及经磁共振成像(MRI)筛选的WUIS溶栓患者(WUIS组46例),MRI筛选采用弥散加权成像(DWI)-液体衰减反转恢复序列(FLAIR)不匹配技术,即DWI呈高信号而FLAIR无高信号。对两组患者进行基线临床资料、溶栓安全性及疗效比较。结果两组患者年龄、性别、高血压病史、糖尿病病史、卒中或短暂性脑缺血发作(TIA)病史、房颤病史、吸烟史、溶栓前收缩压、溶栓前舒张压、溶栓前血糖、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分等基线临床资料比较,差异均无统计学意义(P>0.05)。标准溶栓组和WUIS组患者溶栓后24 h NIHSS评分、症状性脑出血发生率(3.1%与4.3%)、3个月时死亡率(1.8%与4.3%)、3个月时预后良好率(69.3%与65.2%)比较,差异均无统计学意义(P>0.05)。结论对磁共振成像DWI-FLAIR不匹配指导的WUIS患者行阿替普酶静脉溶栓治疗是安全、有效的。
Objective To investigate the effect of intravenous thrombolytic therapy of alteplase in patients with waking after cerebral infarction (WUIS) under the instruction of image. Methods A total of 209 patients with cerebral infarction treated with intravenous thrombolysis with alteplase were divided into three groups: thrombolytic therapy (163 in thrombolytic group) and WUIS thrombolysis in MRI Patients (WUIS group, 46 cases), MRI screening using diffusion weighted imaging (DWI) - fluid attenuation inversion recovery sequence (FLAIR) mismatch technique, that is, DWI was high signal and FLAIR no high signal. Baseline clinical data of two groups of patients, thrombolytic safety and efficacy comparison. Results The age, gender, history of hypertension, history of diabetes mellitus, history of stroke or transient ischemic attack (TIA), history of atrial fibrillation, smoking history, systolic blood pressure before thrombolysis, diastolic blood pressure before thrombolysis, Blood glucose, baseline NIHSS scores before thrombolysis were not significantly different (P> 0.05). The NIHSS score, the incidence of symptomatic intracerebral hemorrhage (3.1% and 4.3%), the mortality at 3 months (1.8% vs 4.3%) in the standard thrombolysis group and the WUIS group at 24 hours after thrombolysis, and the prognosis was good at 3 months Rates (69.3% vs. 65.2%) showed no significant difference (P> 0.05). CONCLUSIONS: It is safe and effective to perform intravenous thrombolytic therapy with alteplase in WUIS patients who do not match MRI with DWI-FLAIR.