天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (12): 1437-1439.doi: 10.11958/j.issn.0253-9896.2015.12.024

• 应用研究 • 上一篇    下一篇

CT 灌注成像技术指导下急性脑梗死溶栓治疗的疗效评估

高路燕，王洪新△，梁佩芬，董银华，赵岚，唐江伟，李强，范宏光，周丽娜   

  1. 天津市第四中心医院神经内科（邮编300140）
  • 收稿日期:2015-05-08 修回日期:2015-07-29 出版日期:2015-12-15 发布日期:2015-12-11
  • 通讯作者: △通讯作者E-mail:wh1963919@163.com E-mail:wanghongxinde@126.com
  • 作者简介:高路燕（1982），女，主治医师，硕士，主要从事脑血管病研究
  • 基金资助:
    天津市卫生局科技攻关课题资助项目（11KG146)

Effect of CTP guided thrombolytic therapy in the treatment of acute cerebral infarction

GAO Luyan, WANG Hongxin△, LIANG Peifen, DONG Yinhua, ZHAO Lan, TANG Jiangwei, LI Qiang, FAN Hongguang, ZHOU Lina   

  1. Department of Neurology, Tianjin Fourth Central Hospital, Tianjin300140,China
  • Received:2015-05-08 Revised:2015-07-29 Published:2015-12-15 Online:2015-12-11
  • Contact: △Corresponding Author E-mail: wh1963919@163.com E-mail:wanghongxinde@126.com

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摘要： 目的探讨CT 灌注成像技术（CTP）指导下急性脑梗死溶栓治疗的效果。方法发病6 h 内的急性脑梗死患者200 例，溶栓前均行CTP 检查，根据CTP 检查结果，分为存在半暗带组和不存在半暗带组，用重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓，观察2 组患者溶栓前后美国国立卫生研究院卒中量表（NIHSS）评分、Barthel 指数（BI）、改良Rankin 量表（mRS）评分以及出血性转化等事件，评估2 组患者治疗有效率、良好预后率。结果与不存在半暗带组（6.67±3.46）比较，存在半暗带组患者溶栓7 d 后NIHSS 评分明显降低（4.76±2.04），4 周时降低最明显（3.68±1.93）。存在半暗带组4 周时有效率（60.3%）、3 个月时良好预后率（71.7%）均明显优于不存在半暗带组（34.7%， 56.8%）。结论CTP 指导下rt-PA 静脉溶栓治疗安全有效，可根据半暗带扩大溶栓治疗窗，并且出血转化率低。

关键词: 脑梗死, 组织型纤溶酶原激活物, CT 灌注成像, 静脉溶栓

Abstract: Objective To investigate the effect of CT perfusion (CTP) imaging guidance in the treatment of acute cere⁃ bral infarction. Methods Patients (n=200) with acute cerebral infarction who visited our clinic within 6 hours underwent CTP examination and were divided into two groups: penumbra group and non-penumbra group according to their CTP imag⁃ ing (presence of penumbra or not). Recombinant tissue plasminogen activator (rt - PA) was administrated for intravenous thrombolysis in both groups. NIHSS (The NIH Stroke Scale), BI (Barthel Index), mRS (modified Rankin Scores) and hemor⁃ rhagic transformation events of two groups were determined before and after thrombolysis to evaluate its effect and prognosis in these two group. Results Compared with non penumbra group, NIHSS was reduced in penumbra group from 7 days after rt-PA (6.67±3.46 vs 4.76±2.04), and this decrease became obvious at 4 weeks after rt-PA (6.67±3.46 vs 3.68±1.93). Effi⁃ ciency rate at 4 week (60.3%) and good prognosis rate at 3 months（71.7%）were both significantly improved in penumbra group than those in non penumbra group（34.7%，56.8%）. Conclusion rt-PA under CTP guidance is effective and safe in the treatment of acute cerebral infarction. The thrombolytic therapy window can be enlarged according to the presence of pen⁃ umbra or not and the bleeding conversion rate remains at low level.

Key words: brain infarction, tissue plasminogen activator, CT perfusion imaging, intravenous thrombolysis