重组组织型纤溶酶原激活物rt-PA静脉溶栓治疗超早期脑梗死  

Intravenous thrombolytic therapy with recombinant-tissue plasminogen activator for super early stage of cerebral infarction

作　　者：樊双义[1] 王天昊[1] 何宝明[2] 刘景峰[1] 马朋林[1] 

机构地区：[1]解放军总医院第二附属医院急救部,北京100091 [2]解放军总医院第二附属医院放射科,北京100091

出　　处：《解放军医学杂志》2009年第4期463-466,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨应用扩散加权成像(DWI)、灌注成像(PWI)以及其他磁共振(MRI)技术界定超早期脑梗死缺血半暗带的可行性,并判断在超早期(发病6h内)应用重组组织型纤溶酶原激活剂(rt-PA)进行溶栓治疗的临床疗效及安全性。方法选择2003年7月至2007年3月解放军总医院第二附属医院急诊科发病时间在2～6h的超急性脑梗死患者30例行MRI检查(包括DWI、PWI及其他磁共振技术)。采用rt-PA进行溶栓,剂量0.9mg/kg,静脉滴注。另设30例普通常规治疗患者(未做溶栓治疗)作为对照。利用美国国立卫生研究院卒中量表评分(NIHSS),比较治疗前后神经功能缺损情况及凝血功能指标。结果溶栓组治疗后1hNIHSS(21.0±2.65)较溶栓前(25.18±2.98)明显降低(P<0.05);溶栓后30dNIHSS(12.66±4.25)明显低于对照组(19.12±2.89,P<0.05)。治疗后1～60d,各时间段溶栓组患者NIHSS评分均低于对照组(P<0.05)。治疗后30d溶栓组的治愈率、显效率、总有效率分别为32.3%、64.2%、87.4%,显著高于对照组15.4%、27.5%、42.8%(P<0.05)。溶栓组治疗60d后NIHSS评分(10.25±3.15)显著低于治疗前(25.18±2.98,P<0.05)。溶栓组发生脑出血2例,预后仍然良好。两组患者均无死亡病例。结论综合应用DWI、PWI和MRI可发现超早期脑梗死,并预测缺血半暗带。在严格掌握溶栓治疗适应证的基础上应用rt-PA超早期静脉溶栓治疗脑梗死,临床疗效好,并发症少。Objective To outline ischemic penumbra in hyperacute cerebral infarction with diffusion weighted imaging （DWI）, perfusion weighted imaging （PWI） and magnetic resonance imaging （MRI）, so as to evaluate the clinical effect and safety of ultra-early intravenous thrombolysis with recombinanwtissue plasminogen activator （rt-PA） in treatment of cerebral infarction. Methods MRI techniques, including DWI, PWI and other MRI technique, were performed in 30 patients with clinically diagnosed hyperacute cerebral infarction. The NIH Stroke Scale （NIHSS） and the blood clotting parameters were compared in 30 patients before and after thrombolysis with intravenous infusion of rt-PA 0.9mg/kg within 6h after onset of cerebral infarction. Meanwhile, another 30 cases with cerebral infarction treated with routine drugs served as control. Results The NIHSS score declined markedly at lh after thrombolysis compared with that before thrombolysis （21.0±2. 65 vs 25. 18±2. 98, P〈0.01）, and the NIHSS score decreased significantly at day 30 after thrombolysis compared with that in control＇group （12. 66±4. 25 vs 19. 12±2.89, P〈0. 01）. All the cure rate, effectual rate and total effective rate evaluated 30 days after thrombolysis were higher than those in control group （32. 3%, 64.2% and 87. 4% vs 15. 4%, 27. 5% and 42.8%, respectively. P〈 0. 01）. Two patients had cerebral hemorrhage complication after thrombolysis, but the outcome was satisfactory. No death occurred in both groups. Conclusion It is revealed that, based on the strict judgment of indications, ultra-early intravenous thrombolysis with 0. 9mg/kg of rtPA in the treatment of cerebral infarction may give a better clinical curative effect with less complication than traditional therapy.

关 键 词：脑梗塞 组织型纤溶酶原激活物 缺血半暗带 溶栓 

分 类 号：R743.33[医药卫生—神经病学与精神病学]