静脉溶栓治疗内囊预警综合征七例  

Intravenous thrombolysis in the treatment of capsule warning syndrome in 7 cases

作　　者：刘志华[1] 张瑾 方思伟 丘鸿凯[1] LIU Zhi-hua;ZHANG Jin;FANG Si-wei;QIU Hong-kai(Department of Neurology,Zhongshan Boai Hospital Affiliated to Southern Medical University,Zhongshan 528400,Guangdong,CHINA)

机构地区：[1]南方医科大学附属中山市博爱医院神经内科,广东中山528400

出　　处：《海南医学》2022年第5期623-625,共3页Hainan Medical Journal

摘　　要：目的探讨内囊预警综合征(CWS)患者急性期的干预措施。方法回顾性分析2014年6月至2019年6月在南方医科大学附属中山市博爱医院就诊的CWS患者的临床资料,其中7例患者经抗血小板治疗后卒中症状再发且持续20 min未能缓解后启动静脉溶栓补救治疗。结果7例患者在72 h内共完成8次静脉溶栓补救措施,5次完全缓解,2次部分缓解,1次无效,静脉溶栓补救措施的及时有效率为87.5%(7/8),所有患者均无颅内出血;首次溶栓有效的5例患者48 h内短暂性脑缺血发作(TIA)仍有复发,但发作频率较溶栓前下降,其中3例最终进展为完全性卒中,1例自行缓解,1例予以再次溶栓治疗后症状缓解;5例患者72 h后磁共振弥散加权成像(DWI)提示基底节或脑干有高信号影,其中4例患者遗留有肢体症状,但6个月后随访改良Rankin量表(MRS)评分1~2分。结论时间窗内的静脉溶栓治疗可能是CWS患者抗血小板治疗失败后重要的补救措施之一。Objective To explore the intervention measures in acute stage of patients with capsule warning syndrom(CWS).Methods The clinical data of CWS patients treated in Zhongshan Boai Hospital Affiliated to Southern Medical University from June 2014 to June 2019 were retrospectively analyzed.Among them,there were 7 patients who had recurrent stroke symptoms after antiplatelet therapy and failed to relieve after 20 minutesm,while started intravenous thrombolytic therapy.Results Seven patients completed 8 intravenous thrombolysis remedial measures within 72 h,inculding 5 complete remissions,2 partial remissions and 1 ineffective.The timely effective rate of intravenous thrombolysis remedial measures was 87.5%(7/8),and all patients had no intracranial hemorrhage.Five patients who were effective for the first thrombolysis still had TIA recurrence within 48 hours,but the attack frequency decreased compared with that before thrombolysis.Among them,there were 3 cases eventually developed into complete stroke,1 case relieved by itself,and 1 case relieved after thrombolytic therapy again.MRI-DWI showed high signal shadow in basal ganglia or brainstem after 72 hours in 5 patients,4 of which had limb symptoms,with the follow-up modified rankin scale(MRS)of 1 to 2 after 6 months.Conclusion Intravenous thrombolytic therapy within the time window may be one of the important remedial measures for CWS patients after antiplatelet therapy failure.

关 键 词：短暂性脑缺血发作 内囊预警综合征 静脉溶栓 进展性脑卒中 抗血小板治疗 

分 类 号：R442.8[医药卫生—诊断学]