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目的探讨发病4.5h内孤立性脑桥梗死患者静脉溶栓的短期预后和安全性。方法选择静脉溶栓登记的605例患者,其中静脉溶栓后经头颅MRI证实的孤立性脑桥梗死29例(脑桥梗死组),基底节区梗死59例(基底节区梗死组)。对比分析2组患者临床特征、危险因素、实验室检查和出院时、90d的良好预后(改良Rankin量表评分≤2分)及颅内外出血发生率;同时观察孤立性脑桥梗死患者静脉溶栓后神经功能缺损进展或波动的发生情况。结果脑桥梗死组溶栓前纤维蛋白原水平明显高于基底节区梗死组[(3.7±1.2)g/L vs(3.2±0.9)g/L,P=0.037]。2组良好预后在出院时(51.7%vs 62.7%,P=0.324)和90d(86.2%vs 78.0%,P=0.375)比较,差异无统计学意义。29例脑桥梗死患者中,12例发生进展或波动,6例(50.0%)出院时预后良好,只有1例(8.3%)90d预后不良。结论孤立性脑桥梗死超急性期静脉溶栓可能是有效和安全的。尽管溶栓后神经功能缺损进展或波动发生高,但短期预后仍较好。
Objective To investigate the short-term prognosis and safety of intravenous thrombolysis in patients with solitary pontine infarction within 4.5 hours of onset. Methods Sixty-five patients with venous thrombolysis were enrolled, including 29 cases of isolated pontine infarction (pontine infarction group) and 59 cases of basal ganglia infarction (basal ganglia infarction group) confirmed by cerebral MRI after intravenous thrombolysis. The clinical features, risk factors, good prognosis at 90 days (modified Rankin scale score≤2 points) and the incidence of intracranial hemorrhage were compared between the two groups. The venous thrombolysis in patients with solitary pontine infarction Neurological deficits or fluctuations in the progress of the situation. Results The level of fibrinogen before thrombolysis in patients with pontine infarction was significantly higher than that in patients with basal ganglia infarction [(3.7 ± 1.2) g / L vs (3.2 ± 0.9) g / L, P = 0.037]. There was no significant difference in good prognosis between the two groups (51.7% vs 62.7%, P = 0.324) and 90 days (86.2% vs 78.0%, P = 0.375) at discharge. Of the 29 patients with pontine infarction, 12 developed or fluctuated, and 6 (50.0%) had a good prognosis at discharge and only 1 (8.3%) had a poor prognosis at 90 d. Conclusion The acute thrombolytic therapy of isolated pontine infarction may be effective and safe. Despite thrombolysis neurological deficits or fluctuations in the occurrence of high, but the short-term prognosis is still good.