颅内大动脉狭窄对MRI指导的超急性脑梗死静脉溶栓疗效的影响  

Magnetic Resonance Imaging Guided Intravenous Thrombolysis for Hyperacute Ischemia Stroke with and without Large Intracranial Artery Stenosis

作　　者：杨娟[1] 白青科[1] 赵振国[2] 隋海晶[2] 谢秀海[2] 赵晓晖[1] 陆练军[1] 沈健[1] 陈娟[1] 

机构地区：[1]上海市浦东新区人民医院神经内科 [2]上海市浦东新区人民医院放射科

出　　处：《中国医学计算机成像杂志》2012年第6期490-493,共4页Chinese Computed Medical Imaging

基　　金：浦东新区卫生系统重点学科建设基金(PWZXK2010-03);浦东新区卫生系统领先人于培养基金(PWR12010-02);上海浦东新区卫局项目及科技发展基金创新项目(PW2011B-7;PW2009A-12.PKJ2010-Y28)~~

摘　　要：目的:探讨有无合并颅内大动脉狭窄对MRI指导下超急性期脑梗死重组组织型纤溶酶原激活剂(rtPA)静脉溶栓治疗疗效影响。方法:选择发病12h以内头颅CT阴性且多模式MRI筛选符合溶栓标准的148例脑梗死患者,给予rt-PA 0.9mg/kg静脉溶栓治疗,采用美国国立卫生研究院卒中量表评分(NIHSS)、Barthel指数(B1)及90d改良Rankin评分(mRS),评定溶栓治疗前与治疗后的神经功能。结果:颅内大动脉有狭窄的患者57例,溶栓治疗后7d NIHSS评分预后良好32例(56%),90d预后良好49例(86.0%);颅内大动脉无狭窄的患者91例,7d NIHSS评分疗效良好51例(56.0%),90d疗效良好81例(89.0%)。在7d时间点和190d时间点,颅内大动脉有狭窄和无狭窄两组预后差异均无统计学意义(P>0.05),两组神经功能评分均为90d优于7d时间点。90dBI指数及mRS评分无狭窄组均较有狭窄组预后良好(P<0.01)。对颅内大动脉狭窄患者而言,不同发病时间段的患者行rt-PA静脉溶栓后NIHSS评分、BI指数及mRS评分均无统计学意义(P>0.05)。结论:MRI指导下对发病12h内超急性期脑梗死行rt-PA静脉溶栓疗效良好率无显著性差异,颅内大动脉无狭窄者预后更好;且颅内大动脉狭窄组<4.5h及4.5～12h时间窗静脉溶栓疗效无明显差异。Purpose： To evaluate the efficacy of MRI-guided intravenous thrombolysis with recombinant tissue plasminogen activator （rt-PA） for hyperacute ischemia stroke with and without large intracranial artery stenosis. Methods： A total of 148 patients with hyperacute ischemia stroke were enrolled. All patients showed normal CT scan and met multimodality MRI criterion and were administrated with intravenous rt-PA （0.9mg/kg）. The NIHSS （National Institutes of Health Stroke Scale） score was assessed before and after treatment. Barhtel Index （BI） and Modified Rankins Score （mRS） on 90th day were also assessed. Results： Fifty- seven patients with large intracranial artery stenosis received rt-PA therapy. On 7th day, thirty-two of them （56.0%） got good prognosis by NIHSS score; and on 90th day, forty-nine of them （86.0%） got good prognosis by NIHSS score. Ninety-one patients without large intracranial artery stenosis received rt-PA therapy. On 7th day, fifty-one of them （56.0%） got good prognosis by NIHSS score; and on 90th day, eighty-one of them （89.0%） got good prognosis by NIHSS score. There was no difference of prognosis between the patients with and without large intracranial artery stenosis either on 7th day or 90th day after rt-PA therapy （P〉0.05）. But the prognosis was better on 90th day than that on 7th day for both the patients with and without large intracranial artery stenosis. The BI and MRs assessed on 90th day of the patients without large intracranial artery stenosis were better than that of the patients with large intracranial artery stenosis （P〈0.01）. There was no difference of prognosis among different time windows （〈4.5h, 4.5-12h） in the patients with large intracranial artery stenosis after received rt-PA therapy （P〉0.05）. Conclusion： MRI-guided intravenous thrombolysis with rt-PA within 12 hours after symptom onset for hyperacute ischemia stroke is safe and effective. The prognosis of patients without large intracranial artery stenosis i

关 键 词：脑梗死 磁共振成像 重组组织型纤溶酶原激活物 血栓溶解疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]