急性缺血性脑卒中静脉溶栓血管再通后脑水肿的发生、演变及转归  

Occurrence,evolution and outcome of cerebral edema after vessel recanalization in patients with acute ischemic stroke undergoing intravenous thrombolysis

作　　者：廖艳红[1] LIAO Yanhong(Department of Geriatric Demonstration,Beijing Geriatric Hospital,Beijinng 100095,China)

机构地区：[1]北京老年医院老年示范病房

出　　处：《河北医药》2019年第19期3004-3006,共3页Hebei Medical Journal

摘　　要：目的分析急性缺血性脑卒中患者在溶栓治疗血管再通后患者脑水肿的发生、演变及转归情况。方法将神经内科收治的78例急性缺血性脑卒中溶栓治疗后血管再通患者依据溶栓再通时间进行分组,其中≥1 h、<3 h内溶栓再通43例(≥1 h、<3 h组)、3~4.5 h内溶栓再通35例(3~4.5 h组),对2组患者进行头颅CT监测,并对2组患者的预后转归情况进行分析。结果≥1 h、<3 h组患者脑水肿发生率(23.26%)显著低于3~4.5 h组(48.57%),差异有统计学意义(P<0.05);≥1 h、<3 h组与3~4.5 h组溶栓治疗前、溶栓治疗3个月、6个月后NIHSS评分差异无统计学意义(P>0.05),溶栓治疗1周后≥1 h、<3 h组NIHSS评分显著低于3~4.5 h组(P<0.05);2组患者溶栓后1周、3个月、6个月NIHSS评分较本组溶栓治疗前均显著降低(P<0.05)。≥1 h、<3 h组预后不良发生率(20.93%)低于3~4.5 h组(25.71%),但差异无统计学意义(P>0.05)。结论急性缺血性脑卒中患者溶栓治疗血管再通脑水肿的发生率极高,血管的再通有利于脑内局部循环的改善,逐渐促进患者的康复,且再通时间越晚,患者的脑水肿发生情况越严重。Objective To analyze the occurrence,evolution and outcome of cerebral edema after vessel recanalization in patients with acute ischemic stroke(AIS)undergoing intravenous thrombolysis(IVT).Methods Seventy-eight patients with AIS who underwent IVT for vessel recanalization in Department of Neurology were divided into two groups according to time of vessel recanalization,including vessel recanalization in≥1 h、3 h group(n=43)and vessel recanalization in 3~4.5h group(n=35).The patients in both groups underwent CT scan,and the prognosis of the two groups was analyzed.Results The incidence of cerebral edema in patients of≥1 h、3 h group(23.26%)was significantly lower than that in 3~4.5 h group(48.57%),and the difference was statistically significant(P<0.05).There was no significant difference in NIHSS scores between≥1 h、3 h group and 3~4.5h group before thrombolytic therapy,and 3 and 6 months after thrombolytic therapy(P>0.05).The NIHSS scores were significantly lower in≥1 h、3 h group than in 3~4.5 group after 1 week of thrombolytic therapy(P<0.05).The NIHSS scores of the two groups at 1 week,3 months,and 6 months after thrombolytic therapy were significantly lower than those before thrombolytic therapy(P<0.05).The incidence of poor prognosis in the≥1 h、3 h group(20.93%)was lower than that in the 3~4.5h group(25.71%),but the difference was not statistically significant(P>0.05).Conclusion The incidence of cerebral edema in patients with AIS is extremely high.The vessel recanalization is beneficial to the improvement of local circulation in the brain,and gradually promotes the rehabilitation of patients.The later the recanalization is,the more serious cerebral edema will be in the patient.

关 键 词：急性缺血性脑卒 溶栓 血管再通 脑水肿 转归 

分 类 号：R743.33[医药卫生—神经病学与精神病学]