r—tPA动脉溶栓治疗超时间窗急性脑梗死  

Intra -arterial thrombolysis with r-tPA for the treatment of acute cerebral infarction 6 to 9 hoursafter onset

作　　者：毕敏[1] 童绥君[1] 张艺丹[1] 江斌[1] 陈汉水[1] 马琪林[1] 

机构地区：[1]厦门大学附属第一医院神经内科,福建省厦门361003

出　　处：《中华急诊医学杂志》2013年第4期414-417,共4页Chinese Journal of Emergency Medicine

基　　金：福建省科技厅重点项目（2008Y01011292）

摘　　要：目的研究cT灌注指导下r—tPA动脉溶栓治疗6～9h时间窗内急性脑梗死的疗效与安全性。方法前瞻对照研究2008年1月至2010年12月厦门大学附属第一医院神经内科收治的脑梗死患者，将63例发病6～9h内CT灌注成像提示存在缺血半暗带的急性脑梗死患者随机（随机数字法）分为A、B两组，A组给予r—tPA动脉接触溶栓，B组给予常规抗血小板等治疗。各组患者在治疗前、治疗后24h和7d行NIHSS评分，90d行mRS及BI评分以评定临床预后；A组患者术前、术后行脑血管DSA检查，判定闭塞血管再通情况；两组患者24h内均复查颅脑CT，观察是否合并脑出血。结果A组30例，B组33例；治疗前后比较，NIHSS评分差异24h时A组差异有统计学意义（P〈0．01），B组差异无统计学意义（P〉0．05），7d时两组均有统计学意义（P〈0．01），组问比较显示A组较B组在治疗后24h、7d时NIHSS评分下降更显著（P〈0．01）；治疗后90d良好预后者A组明显多于B组（P〈0．05）；A组溶栓治疗后成功再通20例（66．67％），24h内有2例并发脑出血，与B组比较差异无统计学意义（P〉0．05）。结论CT灌注指导下r-tPA动脉溶栓是治疗6～9h时间窗内急性脑梗死的一种安全有效方法。Objective To determine the safety and efficacy of intra-arterial recombinant tissue plasminogen activator （ r-tPA ） for the treatment of acute cerebral infarction （ ACI ） in patients under the guidance of computed tomography perfusion-based selection within a 6 - 9 hour window. Methods Sixtythree ACI patients selected by using computed tomography perfusion imaging （CTPI） identifying thresholds for salvageable penumbra were randomly （random number） assigned to the group treated with intra-arterial thrombolysis with r-tPA （group A, n = 30 ） or to the group managed with conventional anti-platelet aggregation agent （group B, n = 33 ） within a 6-9 hour window. The National Institutes of Health Stroke Scale （NIHSS） and the modified Rankin Scale score （mRS） and Barthel Index （BI） were used for evaluating therapeutic efficacy. Global brain digital subtraction angiography （DSA） was done pre-and post- treatment to observe the reeanalization of occluded vessels in the group A. All patients were monitored with CT scan within 24 hours to determine the cerebral hemorrhage, an unexpected complication of thrombolysis. Results Compared with pre-treatment, there were significant differences in NIHSS 24 hours after treatment in the group A and 7 days after treatment in both groups （ P 〈 0. 01 ）. However, there were no significantdifferences in NIHSS 24 hours after treatment in the group B. More improvements in NIHSS at 24 hours and 7 days after treatment were observed in the group A than those in group B （P 〈 0. 01 ）, and more patients with favorable outcomes identified by mRS and BI in the group A than those in the group B （P =0. 017 and P = 0. 016, respectively）. In addition, twenty patients were showed successful recanalization in the group A and there were 2 cases of cerebral hemorrhage occurred in the group A, and there was no significant difference in the incidence of cerebral hemorrhage within 24 hours between the two groups （ P 〉 0. 05 ）. Conclusions Intra-arteri

关 键 词：急性脑梗死 动脉溶栓 选择性重组组织型纤溶酶原激活物 CT灌注成像 缺血半暗带 时间窗 血管再通 神经功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]