轻中度急性脑梗死MRI指导下超时间窗静脉溶栓治疗的研究  

The study of MRI-based intravenous thrombolysis with broadened therapeutic window for mild-and-moderate acute cerebral infarction

作　　者：陈翠荣[1] 赵振国[2] 周媛[1] 隋海晶[2] 白青科[1] 黄敬[3] 

机构地区：[1]上海市浦东新区人民医院神经内科,201299 [2]上海市浦东新区人民医院放射科,201299 [3]同济大学附属上海市第十人民医院神经内科

出　　处：《卒中与神经疾病》2014年第6期330-333,共4页Stroke and Nervous Diseases

基　　金：上海市浦东新区卫生系统重点学科建设资助(PWZx2014-15);上海市卫计委基金(20134179);上海市浦东新区科技发展基金(PKJ2013-Y27);上海市浦东新区人民医院重点学科群基金(PRxkq2013-03)

摘　　要：目的 探讨头颅MRI指导下轻中度急性脑梗死超时间窗rt-PA静脉溶栓治疗的安全性和有效性.方法 收集发病12h内的轻中度脑梗死（NIHSS评分≤15分）患者306例,行头颅MR快速成像序列检查,符合溶栓标准131例,其中≤4.5h组84例,4.5～12 h组MRI评价后存在缺血半暗带47例,观察2组患者治疗后出血情况及pod的疗效.结果 ≤4.5h组发生8例脑出血,发生率为9.52％,死亡0例,4.5～12 h组发生6例脑出血,发生率为12.76％,死亡0例,2组患者基线情况、继发脑出血的发生率、90 d NIHSS评分、mRS评分、BI评分均无显著差异（P均＞0.05）.治疗前NIHSS评分与溶栓后6、24 h评分比较,≤4.5h组有明显差异（P＜0.05）,4.5～12 h组均无明显差异（P均＞0.05）;治疗前NIHSS评分与治疗后7d、3月时的评分比较2组差异均明显（P均＞0.05）.结论 对NIHSS评分≤15分且时间窗为4.5～12 h经MRI评价后仍存在缺血半暗带的患者,给予rt-PA静脉溶栓治疗安全有效,预后良好.Objective To evaluate the safety and efficacy of MRI-based intravenous thrombolysis with broadened therapeutic window for mild-and-moderate acute cerebral infarction with recombinant tissue-type plasminosis activator（rt-PA）.Methods 306 cases were primary screened,who had been diagnosed as mildand-moderate cerebral infarction（NIHSS score ≤ 15 points）within 12 hours of acute stroke symptom onset.With the emergent brain MRI scaning,131 cases were confirmed according with the standard of thrombolysis,including 84 cases in group of within 4.5 hours,47 cases in group of 4.5-12 hours.To observe the possibility of intracranial hemorrhage after treatment and ？ the therapeutic effect after 3 months？ in both groups.Results There were 8 cases （9.52％） in group of within 4.5 hours suffered from symptomatic intracranial hemorrhage after thrombolysis and 6 cases （12.76％） in group of 4.5-12 hours.No case died in both groups.There were neither significant difference between two groups in the rate of symptomatic intracranial hemorrhage,nor in the baseline,NIHSS score,mRS score and BI score of 90 days after the thrombolysis therapy.There were significant differences between two groups in NIHSS score before thrombolysis,6 hours and 24 hours after thrombolysis therapy.No significant difference occurred in group of 4.5-12 hours in NIHSS score before thrombolysis,6 hours and 24 hours after thrombolysis therapy.Conclusions Our study suggested that MRI-based rt-PA intravenous thrombolysis with broadened therapeutic window is safe and effective in patients who had been diagnosed as mild-and-moderate cerebral infarction（NIHSS score ≤15 points）within 12 hours of acute stroke symptom onset.

关 键 词：急性缺血性脑卒中 磁共振成像 血栓溶解疗法 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]