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目的探讨急性缺血性卒中接受重组组织型纤溶酶原激活剂(Recombinant Tissue Plasminogen Activator,rt-PA)静脉溶栓治疗后大脑中动脉再通患者的临床预后情况。方法回顾性分析2013年9月至2014年9月,于天津市环湖医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者资料552例。入选患者按照0.9 mg/kg剂量标准,给予rt-PA静脉溶栓治疗。所有患者于溶栓前及溶栓后24 h进行头部MRA检查,采用TICI血管再通分级标准判断大脑中动脉的再通情况。其中根据溶栓后24 h MRA检查结果分为血管再通组(188例),血管未通组(364例)。溶栓前及溶栓后24 h的神经功能缺损评分及疗效判定,采用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)。神经功能的预后评价,采用改良Rankin评分(modified Rankin Scale,mRS)。对2组患者溶栓后颅内出血(intracranial hemorrhage,ICH)、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)的发生率、死亡率、神经功能缺损恢复及预后情况进行统计对比分析。结果血管再通组患者的恢复良好率和预后良好率均高于血管未通组,差异有统计学意义(P<0.05)。血管再通组患者未出现症状性颅内出血,有6例患者出现了非症状性颅内出血。血管再通组及血管未通组的颅内出血发生率、其他部位出血率和住院期间死亡率差异均无统计学意义(P>0.05)。结论研究结果表明,急性缺血性卒中患者在接受静脉溶栓治疗后,大脑中动脉再通的患者较未通患者神经功能缺损症状改善明显。静脉溶栓后,血管再通的患者临床预后获益更大。
Objective To investigate the clinical prognosis of patients with middle cerebral artery recanalization after intravenous thrombolysis with recombinant Tissue Plasminogen Activator (rt-PA) in acute ischemic stroke. Methods A retrospective analysis of 552 patients with acute ischemic stroke receiving intravenous thrombolysis in the Department of Neurology, Central Hospital of Huanhu, Tianjin from September 2013 to September 2014 was performed. Patients were enrolled in rt-PA intravenous thrombolysis at 0.9 mg / kg. All patients underwent MRA before the thrombolysis and 24 h after thrombolysis, and the recanalization of the middle cerebral artery was judged by TICI recanalization standard. According to MRA examination results at 24 h after thrombolysis, the patients were divided into reperfusion group (188 cases) and non-vascular group (364 cases). Neurological deficit score and efficacy determination before and 24 h after thrombolysis were performed using the National Institutes of Health Stroke Scale (NIHSS). Prognostic evaluation of neurological function, using modified Rankin Scale (mRS). The incidences of intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (SICH), mortality, recovery of neurological deficits and prognosis were compared statistically between the two groups. Results The recovery rate and the good prognosis of the patients in the recanalization group were significantly higher than those in the non-recanalization group (P <0.05). Symptomatic intracranial hemorrhage was not seen in the recanalization group, and asymptomatic intracranial hemorrhage occurred in 6 patients. The incidences of intracranial hemorrhage, bleeding in other sites and in-hospital mortality were not significantly different between the revascularization group and the non-vascular group (P> 0.05). Conclusions The results of the study showed that patients with acute ischemic stroke improved significantly in patients with recanalization of the middle cerebral artery compared with those who failed to receive intravenous thrombolysis. Following intravenous thrombolysis, patients with recanalization benefit more from the clinical outcome.