经颅多普勒超声辅助动脉溶栓治疗急性缺血性卒中的临床研究  

Transcranial Doppler-assisted intra-arterial thrombolysis for patients with acute ischemic stroke

作　　者：张强[1] 徐如祥[1] 罗永春[1] 沈春森[1] 何子俊[1] 张浩[1] 潘文龙[1] 王备备[1] 

机构地区：[1]北京军区总医院附属八一脑科医院,北京100700

出　　处：《中华神经医学杂志》2011年第11期1084-1087,共4页Chinese Journal of Neuromedicine

基　　金：首都特色临床医学技术发展研究基金（Z090507017709006）;首都医学发展科研基金（2009-2050）

摘　　要：目的观察应用经颅多普勒超声（TED）辅助动脉接触性溶栓治疗急性缺血性卒中的临床疗效。方法对北京军区总医院附属八一脑科医院自2010年8月至2011年4月收治的22例急性缺血性卒中患者（大脑中动脉闭塞13例，基底动脉闭塞9例）行动脉内超选择插管至闭塞动脉．注入重组人组织型纤溶酶原激活剂（rt-PA）20mg进行接触性溶栓治疗，同时应用TCD对闭塞动脉进行低频（2MHz）、低强度（0．25W／cm^2）超声辅助溶栓治疗。术后即刻及24h时复查头颅CT，观察动脉再通率、颅内出血率，并对术前术后美国国立卫生研究院卒中量表（NIHSS）评分及Barthel指数评分进行比较。结果22例患者溶栓治疗后动脉再通率为77．27％（17／22），其中完全开通率为22．73％（5／22），部分开通率为54．55％（12／22）；出现无症状性颅内出血3例（13．63％），均未发生症状性颅内出血；术后NmSS评分及Barthel指数评分较术前明显提高，显示神经功能恢复良好。结论对急性缺血性卒中患者在有效时间窗内应用低频TCD辅助小剂量rt-PA动脉接触性溶栓治疗，可显著提高闭塞动脉的再通率，明显减少颅内出血的发生，改善患者的预后，具有良好的临床疗效及安全性。Objective To investigate the clinical efficacy oftranscranial Doppler （TCD）-assisted interventional intra-arterial thrombosis in patients with acute ischemic stroke. Methods This clinical trial enrolled 22 patients with acute ischemic stroke （13 with occlusion of the middle cerebral artery within 6 h of symptom onset; 9 with occlusion of the base artery within 12 h of symptom onset）; occlusive arterial cannula was performed and recombinant tissue plasminogen activator （rt-PA, 20 mg） was injected to perform interventional intra-arterial thrombosis; and TCD ultrasonography of low frequency （2 MHz） and low intensity （0.25 W/cm^2） was performed to assist the thrombosis. Cranial CT was performed again right after the operation and 24 h after the operation to observe the recanalization rate and intracranial hemorrhage; NIHSS scores and Barthel index scores were compared before and after the operation. Results The percentage ofrecanalization was 77.27% （17/22）, including 22.73% （5/22） complete recanalization and 54.55% （12/22） partial recanalization; non-symptomatic intracerebral hemorrhage occurred in 3 patients and no symptomatic intracerebral hemorrhage was noted. NIHSS and Barthel index scores after the operation were obviously higher than those before the operation, indicating that favorable outcomes were achieved after thrombosis. Conclusion TCD-assited interventional intra-arterial thrombosis with rt-PA, significantly improving the recanalization rate of occlusive artery and remarkably reducing the happening of intracerebral hemorrhage, can improve the prognosis and enjoy good clinical efficacy and safety in treatment of acute ischemic stroke.

关 键 词：缺血性卒中 动脉溶栓 重组人组织型纤溶酶原激活剂 经颅多普勒超声 

分 类 号：R743.3[医药卫生—神经病学与精神病学]