摘要
目的探讨多模式MRI检查指导的重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性脑卒中的有效性和安全性。方法选择48例符合美国国立神经疾病与卒中研究院试验溶栓标准、CT检查阴性的新发急性缺血性脑卒中患者进行多模式MRI检查,对符合纳入与排除标准者进行重组组织型纤溶酶原激活剂(0.90mg/kg)静脉溶栓治疗,并比较治疗前与治疗后24h、21d和90d美国国立卫生研究所卒中量表评分,治疗前、治疗后21d和90d的Barthel指数评分,以及治疗后90d改良Rankin评分。结果纳入的20例患者治疗前美国国立卫生研究所卒中评分平均为(11.40±4.29)分,溶栓治疗后24h、21d和90d分别降至(6.55±4.33)、(3.95±3.50)和(0.75±0.99)分,各时限之间差异有统计学意义(P<0.01或P=0.010)。溶栓治疗前Barthel指数评分为(18.75±5.45)分,治疗后21d和90d分别升至(60.25±33.48)分和(92.25±12.09)分,各时限比较差异亦有统计学意义(均P<0.01)。溶栓治疗后90d,20例中改良Rankin评分0～1分者14例(70%),2～3分者6例(30%)。无一例发生症状性颅内出血和死亡。结论急性缺血性脑卒中患者于发病超早期(<4.50h)进行重组组织型纤溶酶原激活剂(0.90mg/kg)静脉溶栓治疗安全、有效。多模式MRI检查有助于筛选可能从溶栓治疗中获益的患者,并可剔除存在出血转化风险者。
Objective To evaluate the efficiency and safety of multi-medality magnetic resonance imaging （MRI）-based intravenous thrombolysis with recombinant tissue plasminogen activator （rt-PA） in acute ischemic stroke. Methods In accordance with the criterion of thrombolysis trial of National Institute of Neurological Disorders and Stroke （NINDS）, 48 patients with new onset of acute ischemic stroke were enrolled. All patients were normal in computed tomography （CT） scanning and were scanned by muhi-modality MRI. All patients who met the inclusion and exclusion criterion were treated intravously by rt-PA 0.90 mg/ kg. Compared the National Institutes of Health Stroke Scale （NIHSS） score before, and 24 h, 21 d and 90 d after treatment. Barthel index （BI） score before and 21 d, 90 d after treatment, and modified Rankin score at 90 d after treatment were also assessed. Results Twenty patients who met the criterion were evaluated. The NIHSS score before, and 24 h, 21 d and 90 d after treatment was （11.40 ± 4.29）, （6.55 ± 4.33）, （3.95 ± 3.50）, and （0.75 ± 0.99）, respectively, and there were statistical differences （P〈 0.01 or P= 0.010）. BI score before treatment was （18.75 ± 5.45）, and increased to （60.25 ± 33.48） and （92.25 ± 12.09） respectively at 21 d and 90 d after treatment, and statistical differences were also found （P〈 0.01, for all）. At 90 d after treatment, there were 14 cases （14/20, 70%） with modified Rankin score 0-1, 6 cases （6/20, 30%） with score 2-3. No symptomatic intracranial hemorrhage was seen and no death occurred. Conclusion Intravenous thrombolysis with rt-PA （0.90 mg/kg） is a safe and effective treatment for patients with acute ischemic stroke within 4.50 h after onset. Multi-modality MRI is helpful to choose those patients who may obtain benefit from thrombolysis thera-py and may exclude those who are at risk of bleeding after such treatment.
出处
《中国现代神经疾病杂志》
CAS
2008年第3期226-231,共6页
Chinese Journal of Contemporary Neurology and Neurosurgery
基金
天津市科技发展计划项目(项目编号:06YF-SZSF01700)
天津市卫生局科技基金资助项目(项目编号:04KZ32)
关键词
大脑梗塞
磁共振成像
组织型纤溶酶原激活物
血栓溶解疗法
Cerebral infarction
Magnetic resonance imaging
Tissue plasminogen activator
, Thrombolytic therapy
