影像指导下醒后脑梗死的阿替普酶静脉溶栓治疗  

Image-guided intravenous thrombolysis by alteplase in the treatment of wake-up ischemic stroke

作　　者：王立志[1] 曾玮[1] 周芬芬[1] 

机构地区：[1]惠州市中心人民医院神经内科,516001

出　　处：《中国实用医药》2017年第11期45-48,共4页China Practical Medicine

基　　金：广东省惠州市科技计划项目(项目编号:2014Y016)

摘　　要：目的探讨影像指导下醒后脑梗死(WUIS)患者阿替普酶静脉溶栓治疗的效果。方法 209例阿替普酶静脉溶栓治疗的脑梗死患者的临床资料,分为发病时间4.5 h内溶栓患者(标准溶栓组163例)及经磁共振成像(MRI)筛选的WUIS溶栓患者(WUIS组46例),MRI筛选采用弥散加权成像(DWI)-液体衰减反转恢复序列(FLAIR)不匹配技术,即DWI呈高信号而FLAIR无高信号。对两组患者进行基线临床资料、溶栓安全性及疗效比较。结果两组患者年龄、性别、高血压病史、糖尿病病史、卒中或短暂性脑缺血发作(TIA)病史、房颤病史、吸烟史、溶栓前收缩压、溶栓前舒张压、溶栓前血糖、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分等基线临床资料比较,差异均无统计学意义(P>0.05)。标准溶栓组和WUIS组患者溶栓后24 h NIHSS评分、症状性脑出血发生率(3.1%与4.3%)、3个月时死亡率(1.8%与4.3%)、3个月时预后良好率(69.3%与65.2%)比较,差异均无统计学意义(P>0.05)。结论对磁共振成像DWI-FLAIR不匹配指导的WUIS患者行阿替普酶静脉溶栓治疗是安全、有效的。Objective To investigate effect by image-guided intravenous thrombolysis by aheplase in the treatment of wake-up ischemic stroke （WUIS）. Methods A total of 209 patients with wake-up ischemic stroke treated by image-guided intravenous thrombolysis by alteplase were divided into patients of thrombolysis within 4.5 h after attack （standard thrombolysis group, 163 cases） and patients of WUIS thrombolysis screened by magnetic resonance imaging （MRI） （WUIS group, 46 cases）. MRI screening was taken by diffusion weighted imaging （DWI） - fluid-attenuated inversion-recovery sequency （FLAIR） no matching technique, as high signal in DWI and FLAIR without any high signal. Comparison was made on base line clinical data, thrombolysis safety and curative effect between the two groups. Results There was no statistically significant difference of age, gender, hypertension medical history, diabetes medical history, stroke or transient ischemic attack （TIA） medical history, atrial fibrillation medical history, smoking history, systolic blood pressure before thrombolysis, diastolic blood pressure before thrombolysis, blood glucose before thrombolysis, National Institutes of Health Stroke Scale （NIHSS） score before thrombolysis as base line clinical data between the two groups （P〉O.05）. The differences of NIHSS scores in 24 h after thrombolysis, incidence of symptomatic cerebral hemorrhage （3.1% and 4.3%）, 3-month mortality （1.8% and 4.3%）, 3-mointh good rate of prognosis （69.3% and 65.2%） between the standard thrombolysis group and WUIS group all had no statistical significance （P〉0.05）. Conclusion Implement of intravenous thrombolysis by aheplase for WUIS patients by guidance of magnetic resonance imaging no matching DWI-FLAIR shows its safety and effectiveness.

关 键 词：醒后脑梗死 阿替普酶 溶栓 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.33[医药卫生—诊断学]