摘要
目的探讨多模式MRI指导下的重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死的疗效和安全性。方法选择符合NINDS试验溶栓标准的CT阴性的40例急性脑梗死患者进行多模式MRI检查,筛选出符合溶栓标准的14例脑梗死患者,给予rt-PA0.9mg/kg静脉溶栓治疗,采用美国国立卫生研究院卒中量表评分(NIHSS)、Barthel指数(BI)及90天改良Rankin评分(mRS),评定溶栓治疗前与治疗后的神经功能。结果14例溶栓患者溶栓治疗后NIHSS评分24h(6.42±5.38)分,溶栓治疗后21天(3.64±3.05)分,溶栓治疗后90天(0.86±1.17)分;14例患者溶栓治疗前BI评分(18.93±6.26)分,溶栓治疗后21天(50.36±35.22)分,溶栓治疗后90天(88.93±13.21)分,均较溶栓治疗前明显升高,差异有统计学意义(P<0.01)。结论静脉rt-PA(0.9mg/kg)溶栓治疗发病4.5h之内的急性脑梗死是有效安全的;多模式MRI有助于选择从溶栓中获益并剔除那些存在高度出血性转化的患者。
Objective To evaluate the efficacy and safety of multi-modality MRI-guided intravenous thrombolysis in treatment of acute cerebral infarction. Methods A total of 40 patients with acute cerebral infarction were enrolled. All patients showed normal CT scan and met NINDS thrombolysis criterion. They received scanning by multi-modality MRI to assess risks and potential benefits of thrombolysis. Fourteen patients who had no thrombolysis contraindication were administrated with intravenous recombinant tissue plasminogen activator（rt-PA,0.9 mg/kg）. The assessment using National Institutes of Health Stroke Scale （NIHSS） score and Barthel Index （BI） was made before and after treatment. Modified Rankin＇s Score （mRS） on 90th day was/also assessed. Results Fourteen patients received rt-PA therapy. Their NIHSS score was （6. 42±5. 38） at 24 h, （3.64±3.05） and （0.86±1.17） on 21st day and 90th day after thrombolytic therapy respectively. Their BI score was（18.93±6.26） before therapy, （50.36±35.22） and （88.93±13.21） on 21st day and 90th day after thromolytic therapy respectively. These scores significantly decreased compared with the score before treatment （P 〈 0. 01）. Conclusion Intravenous thrombolysis with rt-PA within 4.5 hours after symptom onset for acute cerebral infarction is safe and effective. Multi-modality MRI is helpful to choosing the patients who may be benefited from thrombolysis therapy and excluding the patients who are at risk of bleeding after thrombolysis.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2008年第7期521-523,共3页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
天津市卫生局科技基金(04KZ32)
关键词
脑梗塞
磁共振成像
组织型纤溶酶原激活物
血栓溶解疗法
brain infarction
magnetic resonance imaging
tissue plasminogen activator
thrombolytic therapy
