急性缺血性脑卒中短期强化内科治疗的早期再灌注特点  

Early reperfusion features of short-term aggressive medical management in patients with acute ischemic stroke

作　　者：杨伟业[1] 陈康宁[1] 史树贵[1] 周振华[1] 胡俊[1] 蒲明军 张超[1] 武文婧[2] 王健[2] 

机构地区：[1]第三军医大学西南医院神经内科,重庆400038 [2]第三军医大学西南医院放射科,重庆400038

出　　处：《第三军医大学学报》2015年第9期921-924,共4页Journal of Third Military Medical University

基　　金：西南医院临床创新基金(SWH2014LC04);西南医院临床课题(SWH2013LC20);重庆市科技计划项目(CSTC2010AA5042)~~

摘　　要：目的比较急性缺血性卒中(acute ischemic stroke,AIS)强化内科治疗前后早期再灌注变化。方法 15例发生在大脑半球一侧的急性缺血性卒中患者,分别在强化内科治疗前及治疗后24 h行磁共振动脉自旋标记(arterial spin labeling,ASL)灌注检查。利用SPM8软件对获得的脑血流图像进行预处理并统计分析,比较治疗前后脑血流量的变化,并对患者进行90 d的随访,主要结局为基于意向性治疗分析的90 d任何卒中事件。结果 15例患者经强化药物治疗后第7天,NIHSS评分从治疗前的(7.20±2.76)明显减低为(5.47±2.56)(P<0.01);随访第90天患者mRS评分从治疗前(3.93±0.26)减低为(3.00±0.66)(P<0.05)。所有患者无终点事件发生。ASL结果显示:与治疗前相比,患者治疗后24 h部分梗死区域局部脑血流量(r CBF)明显增加(P<0.05)。结论强化药物治疗能够改善急性缺血性卒中患者早期部分缺血部位的脑血流量,提高再灌注水平。Objective To evaluate cerebral reperfusion in patients treated with aggressive medical management for acute ischemic stroke. Methods Clinical data of 15 patients with acute ischemic stroke at one side of cerebral hemisphere in our department from September 2013 to June 2014 were collected and analyzed in this study. All the patients received MRI perfusion-arterial spin labeling imaging （ASL） for 2 times, before aggressive medical management and in 24 h later. Cerebral blood flow （CBF） maps were preprocessed by SPM 8 software and compared between pre- and post-treatment. The cohort was followed up for 3 months. An intention-to treat analysis was carried out with primary outcome as any stroke during 90 d of follow-up. Results In 7 d after aggressive treatment, the National Institute of Health stroke scale （NIHSS） were decreased from 7.20± 2.76 before treatment to 5.47 ± 2.56 （ P 〈 0.01 ）. In 90 d after the treatment, modified Rankin Scores （mRS） were deceased from 3.93 ± 0.26 at admission to 3.00 ± 0.66 （ P 〈 0.05 ）. ASL results showed that regional cerebral blood flow （rCBF） was profoundly improved than before treatment （P 〈0.05 ）. Conclusion Aggressive medical management improves early rCBF and reperfusion.

关 键 词：缺血性脑血管病 强化内科治疗 动脉自旋标记 再灌注 

分 类 号：R445.2[医药卫生—影像医学与核医学] R741.05[医药卫生—诊断学]