液体衰减反转恢复序列在觉醒型缺血性脑卒中静脉溶栓中的价值  

Value of fluid attenuated inversion recovery sequence in intravenous thrombolysis for wake-up ischemic stroke

作　　者：符雪涛[1] 周龙江[1] 张新江[1] 侯红玲[1] 

机构地区：[1]扬州市第一人民医院神经内科,225000

出　　处：《中国实用医药》2016年第33期1-3,共3页China Practical Medicine

摘　　要：目的探讨磁共振液体衰减反转恢复（FLAIR）序列指导下的觉醒型缺血性脑卒中（WUIS）患者静脉溶栓治疗的安全性及预后。方法 46例WUIS患者,经头颅CT检查排除颅内出血后,行急诊头颅磁共振检查,筛选出符合超急性期缺血性脑卒中,即弥散加权成像（DWI）出现高信号缺血病灶,而FLAIR序列无相应部位高信号的患者20例,列为WUIS组。同时选取发病时间〈4.5 h,无静脉溶栓禁忌证的急性脑梗死患者60例,列为标准治疗组。分别给予两组患者重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗。在溶栓后24 h对所有患者进行头颅CT复查,明确有无出血转化;在静脉溶栓后3个月对所有患者用改良Rankin量表（mRS）进行临床神经功能评估。结果两组患者基线资料比较差异无统计学意义（P〉0.05）。两组溶栓后24 h、7 d美国国立卫生研究院卒中量表（NIHSS）评分比较差异无统计学意义（P〉0.05）。WUIS组1例（5.0%）患者在溶栓后24 h复查头颅CT时发现有出血转化征象[1例出血性梗死（HI）-1,无HI-2及脑实质出血（PH）-1、PH-2]。标准治疗组有4例（6.7%）出现出血转化（2例HI-1,1例HI-2,无PH-1,1例PH-2）,其中1例（1.7%）出现了症状性出血转化。两组比较差异无统计学意义（P=0.958〉0.05）。静脉溶栓后3个月时,WUIS组有9例（45.0%）临床神经功能恢复良好（mRS 0~2分）,而标准治疗组有20例（33.3%）神经功能恢复良好,两组比较差异无统计学意义（P=0.365〉0.05）。结论磁共振FLAIR序列指导下的WUIS静脉溶栓治疗是安全的,有效的。Objective To investigate safety and prognosis by fluid attenuated inversion recovery（FLAIR）sequence-guided intravenous thrombolysis for wake-up ischemic stroke（WUIS）patients. Methods A total of 46 WUIS patients received emergent head magnetic resonance imaging after elimination of intracranial hemorrhage by head CT. There were 20 patients as WUIS group with super acute stage of ischemic stroke, high signal ischemic lesions in diffusion-weighted imaging（DWI）and no corresponding high signal in FLAIR sequence. Another 60 patients were taken as standard treatment group with onset time 4.5 h and no contraindication of intravenous thrombolysis. The two groups received reconstructive tissue plasminogen activator（rt-PA）for intravenous thrombolysis. CT examination was made in 24 h after intravenous thrombolysis to show hemorrhagic transformation. All patients received clinical neurological function evaluation by modified Rankin scale（mRS）in 3 months after intravenous thrombolysis. Results There was no statistically significant difference of baseline data between the two groups（P〈0.05）. There was no statistically significant difference of national institutes of health stroke scale（NIHSS）scores in 24 h and 7 d after intravenous thrombolysis between the two groups（P〈0.05）. There was 1 case（5.0%）with hemorrhagic transformation in CT examination in 24 h after intravenous thrombolysis in WUIS group [1 case with hemorrhagic infarct（HI）-1, without HI-2, parenchyma hemorrhage（PH）-1, PH-2]. There were 4 cases（6.7%）in the standard treatment group with hemorrhagic transformation（2 cases with HI-1, 1 case with HI-2, no PH-1, 1 case with PH-2）, and 1 case（1.7%）among them had symptomatic hemorrhagic transformation. There was no statistically significant difference between the two groups（P=0.9580.05）. In 3 months after intravenous thrombolysis, WUIS group had 9 cases（45.0%）with good clinical neurological function recovery（mRS 0~2 points）, and the standard treatment g

关 键 词：缺血性脑卒中 磁共振 液体衰减反转恢复 溶栓 临床转归 

分 类 号：R743.3[医药卫生—神经病学与精神病学]