摘要
目的探讨多模式CT指导下t-PA静脉溶栓治疗急性脑梗死有效性与安全性。方法选择发病在3~8小时的急性脑梗死患者,经多模式CT筛选后,在发病9小时内给予静脉纤溶酶原激活物（-t PA）0.9mg/kg溶栓治疗,评估溶栓前、溶栓后24小时及7天的美国国立卫生研究院卒中量表（National Institutes ofHealth Stroke Scale NIHSS）评分,评估溶栓后90天改良Rankin量表（modified Rankin scale,mRS）评分。溶栓后24小时复查多模式CT。结果溶栓前和溶栓后24小时及7天的NIHSS评分分别为（12.47±4.45）、（12.01±5.83）、（12.93±10.02）分（P〉0.05）。溶栓后90天mRS（3.53±1.77）分。90天mRS独立（0~2分）4例,严重残障或死亡（3~6分）11例。14例溶栓前CT血管造影（CTA）检查显示有颅内大动脉狭窄,溶栓后有9例显示狭窄血管再通或部分再通的。结论多模式CT指导下静脉溶栓治疗结果显示超过常规溶栓时间窗的患者临床神经功能改善明显减少。
Objective To discuss the effect and safety of the treatment of acute ischemic stroke by intravenous thrombolysis conducted by multimode CT.Methods The study is a prospective study.Patients with symptoms of acute hemispheric ischemic and arrived at hospital within 3 to 8 hours after onset of symptoms were recruited from Feb 2008 to Jul 2011.Multimode CT scan was performed at presentation before thrombolysis treatment.Multimode CT includes CT angiography（CTA）,and perfusion CT（PCT）.The National Institutes of Health Stroke Scale（NIHSS） score was assessed at baseline,24 hours and 7days after thrombolysis respectively.The modified Rankin scale（mRS） after 90 days by thrombolysis was assessed.Statistics： All the scores were showed as x±s.Compared t test was used to estimate if there was any difference of the baseline NIHSS from that of 24 hours and 7 days after thrombolysis.Wilcoxon signed rank test was used to estimate the difference of vascular grade between pre-and post-thrombolysis.Results Total 15 patients are recruited and 11 of them are male.The mean NIHSS scores at baseline,24 hours and 7 days after thrombolysis were respectively（12.47±4.45）,（12±5.83）,（12.93±10.02）（P0.05）.The mRS of day 90 after treatment was（3.53±1.77）.There were 14 patients with major vascular stenosis at presentation.9 of them experienced partial or total recanalization after thrombolysis and 5 patients had a persistent occlusion.Conclusions Compared with intravenous thrombolysis within 3 hours time window,the good prognosis is obviously decreased in thrombolysis conducted by multimode CT.We assumed the main reason is the prolonged to the treatment time.
出处
《心脑血管病防治》
2012年第5期366-367,370,共3页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
关键词
脑梗死
静脉溶栓
多模式CT
纤溶酶原激活物
Ischemic stroke
Intravenous thrombolysis
Multimode CT
Tissue plasminogen activator
