经颅多普勒超声脑缺血溶栓分级与阿替普酶静脉溶栓治疗急性前循环不同大动脉闭塞性脑梗死预后相关性研究  

The Correlation Study on Thrombolysis in Brain Ischemia(TIBI) Transcranial Doppler Flow Grades and the Outcomes of Ischemic Stroke Patients with Different Proximal Vessel Occlusion in the Anterior Circulation Treated with Intravenous Tissue Plasminogen Act

作　　者：车锋丽[1] 陈胜云[2] 杨中华[3] 赵性泉[2] 杜会山[1] 魏建朝[1] 孟繁花[1] 张伟东[1] 

机构地区：[1]首都医科大学附属北京潞河医院神经内科,北京101145 [2]首都医科大学附属北京天坛医院神经内科 [3]首都医科大学附属北京天坛医院神经病学中心,脑血管病中心,神经重症医学科

出　　处：《中国卒中杂志》2017年第4期302-308,共7页Chinese Journal of Stroke

基　　金：北京市医院管理局“登峰”人才培养计划(DFL20150501);北京市卫生系统高层次卫生技术人才培养计划“学科带头人”(2014-2-010);北京市科学技术委员会资助(Z161100002616008)

摘　　要：目的探讨分析经颅多普勒超声脑缺血溶栓分级与静脉溶栓治疗急性前循环不同大动脉闭塞性脑梗死患者血管再通评价与预后的相关性研究。方法选择急性前循环大动脉闭塞性脑梗死患者,对符合静脉溶栓者给予阿替普酶静脉溶栓治疗,分别于溶栓前及溶栓后24 h行床旁经颅多普勒超声(transcranial Doppler,TCD)检查并记录脑缺血溶栓分级(thrombolysis in brain ischemia,TIBI)。采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分记录患者临床神经功能缺损,3个月随访时采用改良Rankin量表(modified Rankin Scale,m RS)评分评估患者预后,分析前循环不同大血管闭塞性脑梗死患者静脉溶栓前后血管再通情况及患者3个月预后。结果共入选46例患者,其中颈内动脉(internal carotid artery,ICA)闭塞患者19例,大脑中动脉(middle cerebral artery,MCA)闭塞患者27例。溶栓前与溶栓后24 h TCD监测TIBI分级提示血管再通者,ICA闭塞组5.26%,MCA闭塞组55.56%。ICA闭塞组与MCA闭塞组比较,MCA闭塞组90 d随访生活自理及良好预后的比例均高于ICA闭塞组,死亡率低于ICA闭塞组,而两组间溶栓后的症状性颅内出血发生率差异无显著性。结论急性前循环大动脉闭塞性脑梗死经静脉溶栓治疗后可获得血管再通,尤其是MCA闭塞患者;溶栓前后TIBI血流分级变化可反映大动脉血管再通情况,且有助于判断患者临床预后。Objective To investigate and evaluate the intravenous thrombolytic therapeutic recanalization of acute ischemic stroke patients with different large vessel occlusion in the anterior circulation, and the association between thrombolysis in brain ischemia （TIBI） transcranial Doppler flow grades and the outcome of ischemic stroke patients. Methods Patients diagnosed as acute ischemic stroke with a proximal vessel occlusion in the anterior circulation were selected as subjects. Those who were able to receive intravenous thrombolysis were given alteplase intravenous thrombolysis therapy. Thrombolysis in brain ischemia （TIBI） flow grades of large vessels before and 24 h after thrombolysis were assessed by transcranial Doppler （TCD）. National Institutes of Health Stroke Scale （NIHSS） was used to record the neurologic impairment of patients. The modified Rankin Scale （mRS） was used at 3 months follow-up to analyze the recanalization before and after thrombolysis of proximal vessel occlusion in the Anterior Circulation and 3-months prognosis.Results A total of 46 patients were included. There were 19 cases of intemal carotid artery （ICA） occlusion and 27 cases of middle cerebral artery （MCA） occlusion. The 24 h TCD monitored TIBI before and after thrombolysis showed that the rates of recanalization of ICA occlusion group and MCA occlusion group were 5.26% and 55.56%, respectively. For the functional independence outcome at 90 days, MCA occlusion group was significantly better than ICA occlusion group. For excellent recovery outcome at 90 days, MCA occlusion group was also significantly better than ICA occlusion group. For mortality, MCA group was significantly lower than ICA group. There were no significant differences between MCA group and ICA group in the symptomatic intracranial hemorrhage.Conclusion The intravenous thrombolytic therapeutic recanalization of the acute ischemic stroke patients with large vessel occlusion in the anterior circulation was effective, in particular to patients wit

关 键 词：经颅多普勒超声 脑缺血溶栓分级 急性缺血性卒中 静脉溶栓 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]