一站式CT扫描指导颈内动脉夹层致急性缺血性卒中的保守治疗  

Medical treatment of internal carotid artery dissection-induced acute ischemic stroke by one-stop CT scan

作　　者：傅懋林[1] 王双虎[1] 肖雪玲[1] 戴为正[1] 张永刚 何文钦[1] 

机构地区：[1]解放军第180医院神经内科,泉州362000

出　　处：《东南国防医药》2017年第5期457-460,共4页Military Medical Journal of Southeast China

基　　金：南京军区联勤第十八分部医学科技青年培育项目(18FBQN2014011)

摘　　要：目的探讨一站式CT扫描对颈内动脉夹层(ICAD)致急性缺血性卒中内科保守治疗的指导意义。方法选择解放军第180医院2014年3月至2017年3月行一站式CT扫描检查确诊的ICAD致急性缺血性卒中患者临床资料,其中侧支循环好、脑组织灌注好的患者16例(研究组),侧支循环差、脑组织灌注差且拒绝介入手术开通的患者21例(对照组),均进行静脉溶栓或抗凝治疗,评估入出院NIHSS评分改善情况、3个月后改良Rankin评分量表(mRS)评分、半年时血管再通情况及并发症发生率、死亡率等。结果 2组入出院时NIHSS评分变化,研究组明显优于对照组(P<0.05)。2组3个月后临床预后对比,研究组明显优于对照组(P<0.05)。研究组血管再通率明显高于对照组(P<0.05)。2组患者症状性颅内出血、高灌注脑病等并发症的发生率比较差异无统计学意义(P>0.05)。研究组患者病死率明显低于对照组(P<0.05)。结论通过一站式CT扫描评估ICAD致缺血性卒中患者的侧支循环及脑组织灌注情况,于对于侧支循环开放、脑组织灌注好的患者及早行溶栓或抗凝治疗,提高闭塞血管再通率,有助于改善临床预后,降低并发症发生及死亡率,提高患者生存质量。Objective To investigate the significance of one-stop CT scan in guiding the conservative treatment of internal carotid artery dissection-induced acute ischemic stroke. Methods A total of 16 cases of patients who were diagnosed of internal carotid artery dissection-induced acute ischemic stroke with good collateral circulation and normal cerebral perfusion by one-stop CT scan from March 2014 to March 2017,and a total of 12 patients who were diagnosed of internal carotid artery dissection-induced acute ischemic stroke with poor collateral circulation and cerebral perfusion by one-stop unenhanced CT scan in the emergency department in our hospital and refused to undergo interventional surgery over the same period were included in the study,and they were treated with intravenous thrombolysis or anticoagulant therapy. The change of NIHSS scores between admission and discharge,mRS score at the third month,vascular recanalization at the sixth month and the incidence rates and mortality rates of complications were assessed.Results The NIHSS scores of two groups changed between admission and discharge. The study group was significantly better than the control group in the change of NIHSS scores（ P〈0.05）. The clinical prognosis of the study group was significantly better than that of the control group after 3 months（ P〈0.05）. The recanalization rate of the study group was significantly higher than that of the control group（ P〈0.05）. There were no significant differences between the two groups in the incidence rates of symptomatic intracranial hemorrhage,high perfusion encephalopathy and other complications（ P〉0.05）. The mortality rate of patients in the study group were significantly lower than that in the control group（ P〈0.05）. Conclusion Assessing collateral circulation and cerebral perfusion of patients with ICAD induced ischemic stroke through one-stop CT scan and treating patients with open collateral circulation and normal cerebral perfusion with early thrombolytic or anticoagulant the

关 键 词：一站式 CT灌注成像 CT血管重建图像 颈内动脉夹层 内科治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]