不同时间窗脑梗死溶栓后颅内出血及对预后的影响  

Effects of Intravenous Thrombolysis in Different Time Windows on the Intracranial Hemorrhage and Prognosis of Acute Ischemic Stroke

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

机构地区：[1]上海市浦东新区人民医院神经内科,上海201299 [2]上海市浦东新区人民医院放射科,上海201299

出　　处：《昆明医科大学学报》2014年第5期74-77,84,共5页Journal of Kunming Medical University

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养基金(PWRq2013-06);上海市浦东新区科技发展基金创新资金(PKJ2010-Y28)

摘　　要：目的 探讨不同发病时间窗超急性期脑梗死患者接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓后颅内出血情况及对预后的影响.方法 对135例急性期脑梗死患者经过多模式MRI筛选后rt-PA静脉溶栓治疗,分为＜4.5h、4.5～6h和6～12h3组,观察3组患者在溶栓后颅内出血情况,以及对预后的影响.结果 3组时间窗患者在溶栓后颅内出血转化的情况差异无统计学意义（P＞0.05）,溶栓后颅内出血情况与基线NIHSS评分有相关性,6～12h组病例在溶栓后血浆Fbg水平降低（P＜0.05）.结论 基线NIHSS评分高者行rt-PA溶栓治疗易发生出血转化,对于发病时间较长、并且基线Fbg水平偏低的患者,为减少溶栓后出血的风险,应慎重溶栓.Objective To evaluate the effect of intravenous thrombolysis with recombinant tissue plasminogen activator （rt-PA） in different time windows on the intracranial hemorrhage and prognosis of patients with acute ischemic stroke （AIS）.Methods 135 AIS patients received intravenous rt-PA within 12 hours of symptom onset.The patients were divided into ＜ 4.5 h,4.5 h-6 h and 6 h-12 h of three groups by the start time of thrombolytic therapy.The changes of intracranial hemorrhage in patients were observed,and the effects on the prognosis in the three groups were assessed using statistical tests.Results There were no significant differences in the changes of intracranial hemorrhage between these three groups of patients after thrombolysis transformation （P ＞ 0.05）.Risk of intracerebral hemorrhage was closely correlated with scores of NHISS.Fibrinogen level decreased in 24 h after thrombolysis in the group of 6 h-12 h （P ＜0.01） Conclusion Multi-modality MRI-based intravenous thrombolytic therapy to an expanded time window of thrombolysis has no significant effect on the transformation of intracranial hemorrhage,rt-PA treated patients with high scores of NHISS had an increased risk of intracerebral hemorrhage.Fibrinogen levels have obvious changes after treatment in the group of prolonged intravenous thrombolytic therapy.The findings suggest that the thrombolytic treatment should be done carefully,especially in patients with long onset time and low baseline fibrinogen level,in order to reduce the risk of bleeding after thrombolysis.

关 键 词：脑梗死 静脉溶栓 磁共振 颅内出血转化 扩大时间窗 

分 类 号：R743.33[医药卫生—神经病学与精神病学]