论文部分内容阅读
目的:探讨有无合并颅内大动脉狭窄对MRI指导下超急性期脑梗死重组组织型纤溶酶原激活剂(rtPA)静脉溶栓治疗疗效影响。方法:选择发病12h以内头颅CT阴性且多模式MRI筛选符合溶栓标准的148例脑梗死患者,给予rt-PA 0.9mg/kg静脉溶栓治疗,采用美国国立卫生研究院卒中量表评分(NIHSS)、Barthel指数(B1)及90d改良Rankin评分(mRS),评定溶栓治疗前与治疗后的神经功能。结果:颅内大动脉有狭窄的患者57例,溶栓治疗后7d NIHSS评分预后良好32例(56%),90d预后良好49例(86.0%);颅内大动脉无狭窄的患者91例,7d NIHSS评分疗效良好51例(56.0%),90d疗效良好81例(89.0%)。在7d时间点和190d时间点,颅内大动脉有狭窄和无狭窄两组预后差异均无统计学意义(P>0.05),两组神经功能评分均为90d优于7d时间点。90dBI指数及mRS评分无狭窄组均较有狭窄组预后良好(P<0.01)。对颅内大动脉狭窄患者而言,不同发病时间段的患者行rt-PA静脉溶栓后NIHSS评分、BI指数及mRS评分均无统计学意义(P>0.05)。结论:MRI指导下对发病12h内超急性期脑梗死行rt-PA静脉溶栓疗效良好率无显著性差异,颅内大动脉无狭窄者预后更好;且颅内大动脉狭窄组<4.5h及4.5～12h时间窗静脉溶栓疗效无明显差异。
Objective: To investigate the effect of intravenous thrombolysis with recombinant tissue-type plasminogen activator (rtPA) under the guidance of MRI in the treatment of hyperacute cerebral infarction with or without intracranial arterial stenosis. METHODS: A total of 148 patients with cerebral infarction who were screened by thrombolysis within 12 hours after onset of craniocerebral CT (CT) negative and multimodal MRI were treated with rt-PA 0.9 mg / kg intravenous thrombolysis. The NIH Stroke Scale score (NIHSS ), Barthel index (B1) and modified 90th Rankin score (mRS). The neurological function before and after thrombolysis was evaluated. Results: Fifty-seven patients with stenosed intracranial aorta had a good prognosis in 32 NIHSS scores (56%) after thrombolysis and 49 patients (86.0%) with good prognosis at 90d. Ninety-one patients with stenosis of intracranial aorta, The scores were good in 51 cases (56.0%) and good in 90 days (81 cases, 89.0%). There was no significant difference in prognosis between the two groups at 7d and 190d (P> 0.05). The neurological scores of both groups were all better than those of 7d after 90d. The 90dBI index and mRS score without stenosis group were better than those with stenosis group (P <0.01). In patients with intracranial aortic stenosis, NIHSS score, BI index and mRS score were not significantly different between patients with different stages of onset after rt-PA intravenous thrombolysis (P> 0.05). CONCLUSION: There is no significant difference in the curative effect of rt-PA intravenous thrombolysis under the guidance of MRI under the guidance of MRI in 12 h after onset of acute cerebral infarction. The prognosis of intracranial aortic stenosis is better than that of stenosis of intracranial aortic stenosis <4.5 h and 4.5 ~ 12h time window intravenous thrombolysis no significant difference.