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目的探讨临床-弥散加权成像不匹配(CDM)评价溶栓、降纤治疗急性脑梗死的价值。方法发病3-6h的急性脑梗死患者43例,入院后即行弥散加权成像(DWI)检查,并于治疗前行美国国立研究院卒中量表(NIHSS)评分。患者分为溶栓(20例)及降纤(23例)两组,每组患者再根据NIHSS评分及DWI检查结果分为CDM(+)及CDM(-)两亚组。于发病后第30天再次行NIHSS评分。结合CDM比较两种治疗方法改善患者神经功能缺陷的效果。结果对于CDM(+)患者,溶栓治疗前后神经功能缺陷程度显示有显著改善;而降纤治疗前后神经功能缺陷程度未显示显著改善。而对于CDM(-)患者,溶栓或降纤治疗前后神经功能缺陷程度均未显改善。结论 CDM有助于指导临床进行急性脑梗死的选择性溶栓治疗,但不适于指导降纤治疗。
Objective To investigate the value of clinical - diffusion weighted imaging mismatch (CDM) evaluation of thrombolysis and fibrinolytic therapy in acute cerebral infarction. Methods 43 patients with acute cerebral infarction 3-6h after onset were examined by diffusion weighted imaging (DWI) after admission. The NIHSS score was taken before treatment. The patients were divided into two groups: thrombolysis (20 cases) and defibrillation (23 cases). Each group was divided into two subgroups: CDM (+) and CDM (-) according to NIHSS score and DWI. On the 30th day after onset NIHSS score again. Combination of CDM and two treatment methods to improve neurological deficit in patients with the effect. Results In patients with CDM (+), the degree of neurological deficits before and after thrombolytic therapy showed a significant improvement; however, the degree of neurological deficits did not show significant improvement before and after anti-fibrosis treatment. For CDM (-) patients, thrombolysis or fibrinolysis before and after treatment, no significant improvement in neurological deficit. Conclusion CDM can help to guide the clinical choice of thrombolytic therapy for acute cerebral infarction, but it is not suitable for guiding fibrinolytic therapy.