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目的:观察多模式CT对DSA指导下的机械碎栓结合rt-PA动脉溶栓治疗急性脑梗死临床诊断及预后疗效的评估。方法:收集2013年1月至2015年6月收治的经多模式CT筛选出的符合溶栓条件的急性脑栓塞患者30例,年龄38~78岁,平均65岁;病程0.5~6 h。将患者分为<3 h组,16例;3~6 h组,14例。均经多模式CT诊断及评估后,行DSA指导下机械碎栓结合rt-PA动脉溶栓治疗。术后均再次行多模式CT评估血管再通情况并记录溶栓前后NIHSS评分、改良Rankin评分(MRS)及巴塞尔指数(BI)。结果:30例患者的血管再通率达到60%。NIHSS评分显示,<3 h组患者有5例基本痊愈,7例显著进步,总显效率达到75.0%;3~6 h组的患者有3例基本痊愈,5例显著进步,总显效率为57.1%。两组比较,差异无统计学意义(P>0.05)。MRS及BI评分显示,<3 h组有12例临床结局良好,4例临床结局不良,10例预后结果良好,无出血病例;3~6 h组有6例临床结局良好,7临床结局不良,9例预后结果良好,1例症状性脑出血。两组比较,安全性及有效性差异均无统计学意义(P>0.05)。结论:多模式CT诊断及评估机械碎栓结合rt-PA动脉溶栓治疗急性脑梗死是一种安全、有效、可行的方法,该法对于患者的临床预后分析具有一定的指导意义。
OBJECTIVE: To evaluate the clinical diagnosis and prognosis of multi-modal CT in the treatment of acute cerebral infarction under the guidance of DSA-guided mechanical disruption combined with rt-PA arterial thrombolysis. Methods Thirty patients with acute cerebral embolism who underwent thrombolytic therapy were collected from January 2013 to June 2015, aged 38-78 years old (mean, 65 years). The course of disease was 0.5-6 h. Patients were divided into <3 h group, 16 cases; 3 ~ 6 h group, 14 cases. After multi-modal CT diagnosis and assessment, under the guidance of DSA mechanical crush combined with rt-PA arterial thrombolysis. After operation, multi-modal CT was used to assess the recanalization and NIHSS score, modified rankin score (MRS) and Basel index (BI) before and after thrombolysis were recorded. Results: The recanalization rate of 30 patients reached 60%. The NIHSS score showed that 5 patients in <3 h group were basically cured, 7 were significantly improved, and the total effective rate was 75.0%; 3 patients in 3 ~ 6 h group were basically cured, 5 were significantly improved, the total effective rate was 57.1 %. There was no significant difference between the two groups (P> 0.05). Results of MRS and BI showed that 12 patients in <3 h group had good clinical outcomes, 4 patients had poor clinical outcome, 10 patients had good prognosis and no bleeding. 6 patients in 3 ~ 6 h group had good clinical outcomes, 7 poor clinical outcomes, 9 cases of good prognosis, 1 case of symptomatic intracerebral hemorrhage. There was no significant difference in safety and efficacy between the two groups (P> 0.05). Conclusion: Multimodality computed tomography (CT) diagnosis and assessment of mechanical thrombectomy combined with rt-PA arterial thrombolysis in the treatment of acute cerebral infarction is a safe, effective and feasible method. This method is of guiding significance in the clinical prognosis analysis of patients.