急性脑梗死患者多模式CT指导下的静脉溶栓治疗  

Effects of application of muitimode CT evaluation in the intravenous thrombolytic therapy with recombinant tissue plasminogen activator after stroke

作　　者：孙威[1] 丁则昱[2] 张静波[1] 隋欣宁[1] 王玉萍[3] 李雪媛[1] 赵红军[4] 李树昌[4] 廖晓凌[2] 王拥军[2] 

机构地区：[1]大连市第三人民医院神经内科,116033 [2]首都医科大学附属北京天坛医院神经内科 [3]大连市第三人民医院护理部 [4]大连市第三人民医院放射科

出　　处：《中华神经科杂志》2010年第4期256-260,共5页Chinese Journal of Neurology

基　　金：基金项目：国家十一五科技支撑计划资助项目（2006BA101A11）

摘　　要：目的对发病3～9h内的急性脑梗死患者，应用多模式cT指导下静脉rt—PA溶栓治疗，研究其疗效。方法2007年8月至2009年5月于我院就诊，经多模式CT筛选出符合溶栓的患者27例。分为〉3～6h组及7～9h组，记录溶栓前、后的NIHSS、mRS及BI评分，症状性出血率和病死率。结果27例样本中20例（74．1％）患者溶栓治疗有效，11例（40．7％）临床结局良好，5例（18．5％）血管完全再通，症状性出血1例（3．7％）。其中〉3～6h组有效率为92．3％（12／13，x2=4．34，P=0．037），血管再通率38．5％（5／13，x2=6．608，P=0．010）。结论多模式cT指导下〉3～9h溶栓是超过常规溶栓时间窗患者的一种可选择的治疗方法。Objective To test the efficiency and safety of the application of multimode CT evaluation in intravenous thrombolytic therapy with recombinant tissue plasminogen activator （rt-PA） in patients within 〉 3 to 9 hours after stroke. Methods From August 2007 to May 2009, 53 patients within 〉 3--9 h after stroke who visited the Third Hospital of Dalian were randomly recruited. Using multimode CT evaluation, 27 patients eligible to receive intravenous thrombolytic therapy with rt-PA were found and treatment to them within 〉 3--6 h or 7--9 h after onset of isehemlc stroke were given. Their mRS, NHISS and BI were scaled and recorded before and after intravenous thrombolytic therapy. Death rate and symptomatic intracranial hemorrhage rate were calculated. Results After rt-PA treatment, 20 of 27 （74. 1% ） patients had increased clinical activity by 4 points or more on the NIHSS. Favorable outcome rate of patients with mRS were 0 to 1 on 90 d was 40. 1%. Five patients （ 18. 5% ） had recanalization in the occluded arteries after rt-PA treatment. There was 1 patient （3.7%） having symptomatic intracranial hemorrhage （ICH） in our study. In the group given treatment within 〉 3---6 h of onset, the outcome was improved with the effective rate reaching 92. 3% （X2 = 4. 34,P = O. 037 ） , however, the recanalization rate was 38.5% （ X2 = 6. 608, P = 0. 010）. Conclusion Multimode CT evaluation in the rt-PA therapy is an useful tool to select eligible patients beyond 3 hours after acute ischemic stroke to have intravenous thrombolytic therapy with rt-PA.

关 键 词：脑梗死 血栓溶解疗法 组织型纤溶酶原激活物 体层摄影术 X线计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学]