经颅超声对急性缺血性脑卒中血管再通的作用  

The contribution of transcranial ultrasound to arterial recanalization in acute ischemic stroke patients

作　　者：杜敢琴[1] 黄丽娜[1] 富奇志[1] 白树风[1] 郎鸿志[1] 

机构地区：[1]河南科技大学第一附属医院神经内科,洛阳471003

出　　处：《中华物理医学与康复杂志》2012年第9期669-672,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：河南省科技发展计划（112102310143）

摘　　要：目的观察经颅超声对急性缺血性脑卒中患者血管再通的作用。方法选取急性大脑中动脉梗死患者37例，按随机数字表法分为治疗组和对照组，治疗组18例，对照组19例。治疗组采用尿激酶加经颅超声进行治疗，对照组采用尿激酶加安慰剂进行治疗，分别于治疗前、治疗后2h和治疗后24h采用经颅多普勒超声和美国国立卫生研究院脑卒中量表（NIHSS）对患者进行评估。结果治疗组2h和24h的血管再通（完全再通和部分再通）率分别为44．4％和50．0％，对照组2h和24h的血管再通率分别为10．5％和15．7％，组内差异无统计学意义（P〉0．05），组间差异有统计学意义（P〈0．05）；治疗组与对照组不同时间段的NIHSS评分比较，组内及组间差异均无统计学意义（P〉0．05）；治疗组2h和24h的症状改善（NIHSS评分减少≥4分）率分别为33．3％和44．4％，对照组2h和24h的症状改善率分别为5．5％和10．5％，组问比较差异有统计学意义（P〈0．05）；治疗组和对照组2h后均无患者出现症状恶化（N1HSS评分增加≥4分），治疗组24h后的症状恶化率为16．7％，对照组24h后的症状恶化率为10．5％，组间差异无统计学意义（P〉0．05）；治疗组3个月后预后良好（mRS评分≤2分）的发生率为61．1％，对照组3个月后预后良好的发生率为21．0％，组间差异有统计学意义（P〈0．05）。结论经颅超声可以显著提高患者急性脑梗死后的血管再通率，并改善其神经功能。Objective To study the effect of transcranial ultrasound （US） on arterial recanalizatlon in acute isehemic stroke patients. Methods Patients with acute middle cerebral artery （MCA） main stem occlusion after 6 h were randomized into a target group receiving low-frequency, pulse-wave mode, transcranial US for 30 min or a control group. All were treated with intravenous urokinase for thrombolysis. Transcranial doppler sonography （TCD） was used to document vascular occlusion and confirm reeanalization at 2 h and 24 h after treatment, and the patients were evaluated using the National Institutes of Health Stroke Scale （ NIHSS）. Results Recanilization （complete or partial） after 2 hours was significantly higher in the US group （44.4%） compared with the control group （10.5%）. Recanalization had occurred in 50% of the US group 24 hours after treatment compared with 15.7% of the controls. At 2 h after treatment, 33.3% of the US group and 5.5% of the controls had improved at least 4 points on the NIHSS assessment. After 24 hours the figures were 44.4% and 10.5% . After 3 months, ll subjects from US group （61. 1% ） had a modified Rankin score ~〈2 compared with 4 subjects （21%） from the control group. Conclusions In acute ischemic stroke, transcranial US has positive effects on recanalization and neural function.

关 键 词：经颅超声 缺血性卒中 溶栓治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]