CT灌注指导下尿激酶动脉溶栓治疗6-9h急性脑梗死的疗效及安全性分析  

Intra-arterial thrombolysis with urokinase in acute cerebral infarction based on computed tomography perfusion imaging within a 6-9 h window： an efficacy and safety analysis

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

机构地区：[1]福建医科大学第一临床医学院神经内科,厦门大学附属第一医院神经内科,厦门361003

出　　处：《中华神经医学杂志》2013年第11期1101-1105,共5页Chinese Journal of Neuromedicine

基　　金：福建省科技厅重点项目（2008Y01011292）

摘　　要：目的探讨CT灌注指导下尿激酶动脉溶栓治疗6-9h急性脑梗死的疗效与安全性。方法将自2008年1月至2010年12月人住厦门大学附属第一医院神经内科的52例CT灌注成像提示存在缺血半暗带的发病6-9h急性脑梗死患者按随机数字表法分为治疗组（n=27）和对照组（n=25）。治疗组患者行全脑血管造影（DSA），闭塞部位输注尿激酶行接触溶栓治疗，术后评价闭塞血管再通情况；对照组患者予抗血小板聚集等常规治疗。所有患者在治疗后24h内复查CT以观察是否合并脑出血，治疗前及治疗后24h、7d行美国国立卫生研究院卒中量表（NIHSS）评分评定，治疗后90d用改良Rankin量表（mRS）和Barthel指数（BI）评价临床预后。结果治疗组患者溶栓治疗后血管成功再通15例[心肌梗塞溶栓评判标准（TIMI）3级9例，TIMI2级6例]，不成功再通12例（TIMI1级和0级各6例1。治疗后24h内2组脑出血发生率相比差异无统计学意义（P〉0．05）。治疗后24h、7d时治疗组NIHSS评分改善情况明显优于对照组，差异有统计学意义（P〈0．05）：治疗后90d时良好预后（mRS分级0～I级或BI≥95分）比例亦明显高于对照组，差异有统计学意义（P〈0．05）。结论CT灌注指导下尿激酶动脉溶栓治疗发病6-9h急性脑梗死是安全有效的。其可以提高血管再通率，改善临床预后。Objective To determine the safety and efficacy of intra-arterial urokinase in the treatment of acute cerebral infarction （ACI） patients with computed tomography perfusion-based selection within a 6-9 h window. Methods Fifty-two ACI patients, with computed tomography perfusion imaging （CTPI） identifying thresholds for salvageable penumbra, were randomly assigned to intra-arterial thrombolysis with urokinase （group A） and conventional anti-platelet aggregation （group B） within a 6-9 h window. Whole brain digital subtraction angiography （DSA） was done at pre- and post-treatment to observe the recanalization of occlusive vessels in group A. The National Institutes of Health Stroke scale （NIHSS） 24 h and 7 d after treatment, and modified Rankin Scale （mRS） and Barthel Index （BI） 90 d after treatment were used to evaluate the efficacy. Results In group A, 15 patients showed successful recanalization （thrombolysis in myocardial infarction [TIMI] index： grade III in 9 and grade II in 6） and 12 patients showed unsuccessful recanalization （TIMI index： grade I in 6 and grade 0 in 6） with a successful recanalization rate of 55.56%. More obvious NIHSS improvement 24 h and 7 d after treatment in group A was observed than that in group B （P〈0.05）, and more patients with favorable outcomes based on mRS and BI in group A were noted than those in group B （P〈0.05）. In addition, the incidence of cerebral hemorrhage within 24 h of treatment between the two groups was similar （P〉 0.05）.Conclusions Intm-arterial thrombolysis with urokinase is safe and effective for ACI patients within a 6-9 hour window under the guidance of CTPI.

关 键 词：急性脑梗死 动脉内接触溶栓 尿激酶 CT灌注成像 缺血半暗带 

分 类 号：R743.3[医药卫生—神经病学与精神病学]