DWI及MRA指导下尿激酶静脉溶栓治疗超急性期脑梗死的临床研究  

INTRAVENOUS THROMBOLYSIS WITH UROKINASE IN TREATING HYPERACUTE CEREBRALINFARCTION UNDER THE DIRECTION OF MRA AND DWI

作　　者：梁克山[1] 谭兰[2] 

机构地区：[1]山东大学齐鲁医院平邑合作医院神经内科,山东平邑273300 [2]青岛大学医学院附属医院神经内科,山东青岛266000

出　　处：《山东医学高等专科学校学报》2010年第4期273-277,共5页Journal of Shandong Medical College

摘　　要：目的评价在弥散加权磁共振成像(DWI)和磁共振血管成像(MRA)指导下尿激酶(UK)静脉溶栓治疗超急性脑梗死的临床疗效及安全性,并探讨DWI和MRA对超急性脑梗死溶栓的临床应用价值。方法对临床拟诊超急性脑梗死患者在头颅CT、常规MRI的基础上行DWI和MRA检查,根据影像学结果选择治疗方案。对溶栓组45例3h内的超急性脑梗死患者,应用100～150万u尿激酶静脉溶栓治疗,采用欧洲卒中量表(ESS)分别评价治疗前和治疗后2h、6h、1d、2d、3d、7d、14d、30d、90d神经功能恢复状况,Barthel指数评价90d的生活质量。随机选取同年住院发病在6h以上未予溶栓治疗的脑梗死患者60例做为对照组。结果溶栓组ESS分数升高明显,两组间有显著差异。溶栓后2、24h神经功能缺损改善显著(P<0.01)。溶栓组发生脑出血3例。对超早期急性脑梗死,DWI可显示常规MRT2WI不能显示的病灶,MRA则能快速发现血管闭塞的部位或狭窄程度。脑血管病继发癫痫的发病率为4.3%,年龄以60岁以上的老年人为多,继发癫痫的类型以全面性发作为多,皮质病变癫痫发生率高于皮质下,早发型多于迟发型。结论尿激酶静脉溶栓治疗超急性脑梗死有效且相对安全。DWI与MRA联合检查可同时显示脑实质和脑血管情况,为超急性脑梗死早期溶栓治疗提供了切实可行的影像学资料。溶栓治疗后继发癫痫的原因可能与脑缺血再灌注损伤有关。Objective To evaluate the efficacy and safety of intravenous infusion of urokinase in treating hyperacute cerebral infarctions under the direction of diffusion-weighted imaging（DWI）and magnetic resonance angiography（MRA）.Methods The results of DWI and MRA after traditional CT and routine MRI of patients with hyperacute cerebral infarction were analyzed and applied to choose therapy.The thrombolytic therapy group of 45 patients with hyperacute cerebral infarction were treated with 100～150×104u of urokinase as intravenous thrombolytic therapy within 3h after the onset.European Stroke Scale（ESS） were used to evaluate the recovery of neurological functions before the treatment and after the treatment at 2nd hour,6th hour,24th hour,2nd day,3rd day,7th day,14th day,30th day and 90th day.Barthel Index （BI） were used to evaluate the quality of life of 90 days.60 cases without undergoing intravenous thrombolytic therapy after the first attack were chosen to form the contrast group.Results The ESS scores of thrombolysis group were higher,and there was difference between the two groups.Neurological function impairment was improved at 2nd hour and 24th hours after thrombolysis（P0.01）.Cerebral hemorrhage occurred in 3 patients in the thrombolysis group.Hyperacute cerebral infarction could be shown on DWI,which may not be shown on CT and T2WI.Vascular occlusions and stenoses could be detected rapidly through MRA.The occurence rate of secondary epilepsy of cerebrovascular disease was 4.3%.Most cases were seniors and were mostly of generalized seizures.The occurence rates of cortical and early epilepsy was higher than those of subcortical and late epilepsy respectively.Conclusion Intravenous urokinase thrombolysis could be an effective and safe treatment for hyperacute cerebral infarction.Parenchyma and cerebrovascular vessels can be shown by DWI and MRA,thus offering reliable imaging data for thrombolytic therapy.The cause of secondary epilepey may be related to cerebral reperfusion injury.

关 键 词：脑梗死 超急性期 溶栓治疗 尿激酶 弥散加权磁共振成像 磁共振血管成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学]