应用多模MRI指导觉醒性卒中静脉溶栓治疗效果  

Application of Multimodal MRI in Guiding the Therapeutic Effect of Intravenous Thrombolysis for Arousal Stroke

作　　者：陈孝伟[1] CHEN Xiaowei(Department of Neurology,Liaocheng Second People's Hospital,Linqing,Shandong 252600,China)

机构地区：[1]聊城市第二人民医院神经内科,山东临清252600

出　　处：《大医生》2019年第9期46-47,共2页Doctor

摘　　要：目的探究磁共振成像(DWI-FLAIR)不匹配指导觉醒型卒中(wake-up stroke,WUS)患者静脉溶栓治疗效果及安全性及对脂蛋白磷脂酶A2(Lp-PA2)的影响。方法选取2018年3月至2019年3月聊城市第二人民医院治疗的60例觉醒型卒中患者,入院后进行多模MR评估,一组为弥散加权成像(DWI)序列阳性,液体衰减反转恢复(FLAIR)序列阴性的患者34例为WUS溶栓组,给予阿替普酶溶栓治疗;其余26例患者DWI序列与FLAIR序列匹配组,按照普通脑梗死诊治,将两组患者24 h后颅内出血情况、14 d后的神经功能缺损恢复状况(NIHSS评分),经治疗后Lp-PA2的变化情况及90 d后自我生活能力改善状况(改良Rankin量表评分,mRS)进行对比。结果WUS溶栓组和对照组24 h、14 d后NHISS评分、Lp-PA2均明显降低(P<0.05),溶栓90 d后WUS溶栓组和对照组的MRS评分比较,差异有统计学意义(P<0.05)。结论对于WUS患者可采用DWI-FLAIR不匹配现象争取更多早期行静脉溶栓治疗,预后良好。Objective To investigate the effect and safety of magnetic resonance imaging(DWI-FLAIR)mismatch in patients with wake-up stroke(WUS)and its effect on lipoprotein phospholipase A2(Lp-PA2).Methods Sixty patients with arousal stroke who were treated in the Second People's Hospital of Liaocheng from March 2018 to March 2019 were enrolled.Multi-mode MR assessment was performed after admission.One group was positive for diffusion-weighted imaging(DWI)sequence,and the liquid attenuation was reversed.34 patients with negative(FLAIR)sequence were treated with WAST thrombolytic group and treated with alteplase.The remaining 26 patients with DWI sequence and FLAIR sequence were treated according to common cerebral infarction.The intracranial hemorrhage,the recovery of neurological deficit after 14 days(NIHSS score),the change of Lp-PA2 after treatment and the improvement of self-living ability after 90 days(modified Rankin scale score,mRS)were compared.Results The NHISS score and Lp-PA2 were significantly decreased after 24 h and 14 d in the WUS thrombolytic group and the control group(P<0.05).The MRS scores of the WUS thrombolytic group and the control group were compared after 90 days of thrombolysis.Significance(P<0.05).Conclusion For patients with WUS,DWI-FLAIR mismatch can be used to obtain more early intravenous thrombolysis,and the prognosis is good.

关 键 词：觉醒型卒中 DWI-FLAIR不匹配 静脉溶栓 脂蛋白磷脂酶A2 

分 类 号：R74[医药卫生—神经病学与精神病学]