目的：探讨在多模式计算机断层扫描（computed tomography，CT）指导下，急性缺血性卒中4.5～9h重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rtPA）静脉溶栓的有效性及安全性。方法选取在2008至2009年南京大学医学院附属鼓楼医院神经内科临床诊断为急性缺血性卒中且发病时间在4.5～9 h的6例患者为研究对象，经多模式CT筛选后，进行rtPA（0.9 mg/kg）静脉溶栓治疗。溶栓前以及溶栓后2h、24h和7d进行美国国立卫生研究院神经功能缺损评分（National Institutes of Heath Stroke Scale，NIHSS）评估神经功能缺损和恢复情况，溶栓后7d和90d时行巴氏指数量表（Barthel Index，BI））评估日常生活能力和改良Rankin量表（modified Rankin Scale，mRS）评估神经功能，在溶栓后24 h复查多模式C T评估血管再通情况。血管狭窄程度采用缺血性卒中血管栓塞程度量表（Thrombolysis in Cerebral Ischemia Scale，TICI）分级方法。结果在入选的6例患者中，1例患者发生脑出血和病情恶化。6例患者TICI分级评分在溶栓24h后较溶栓前显著升高（2.0+0.71vs 1.0+0.71，P=0.03）。除去1例出血患者，溶栓治疗前后的NIHSS评分分别为12.2±3.27（溶栓前）和9.4±3.78（溶栓后7 d），差异具有显著性（P=0.04）。在日常生活能力方面，与溶栓后7 d相比，BI评分在溶栓后90 d后稍有提高，但差异无显著性（62.5±27.23 vs 47.5±27.84，P=0.13）。患者90d mRS评分较7d mRS评分有所好转，但差异无显著性（4±0.82vs 3±0.82，P=0.09）。结论多模式CT指导下扩大静脉溶栓治疗时间窗对促进卒中患者血管再通、神经功能恢复和日常生活能力提高有促进作用。%Objective To evaluate the effectiveness and safety of the intravenous thrombolysis in acute stroke patients by recombinant tissue plasminogen activator (rtPA) within 4.5~9 hours under the guidance of multimode computed tomography (CT). Methods A total of 6 patients who were clinically diagnosed as acute ischemic stroke and reached hospital within 4.5~9 hours were recruited by Dept. of Neurology of Nanjing Drum Tower Hospital between 2008 and 2009. After the examination of multimode CT, the qualiifed patients were given intravenous thrombolysis treatment with rtPA (0.9mg/kg). The National Institute Health Stroke Scale (NIHSS) was assessed at baseline and 2h, 24h, 7d after the treatment. modiifed Rankin Scale (mRS) and the Barthel Index (BI) at 7d and 90d after the intravenous thrombolysis were calculated to evaluate neurological function and daily life capability respectively. Multimode CT was performed again at 24h after the treatment to calculate the recanalization of vessels. Thrombolysis in Cerebral Ischemia Scale (TICI) score was applied to assess the severity of vessel stenosis. Results Among 6 patients enrolled in the study, one patient developed cerebral hemorrhage. TICI grade score of 6 patients at 24 h after thrombolysis was signiifcantly increased compared with the baseline score (2.0+0.71vs 1.0+0.71,P=0.03). Except for the patients with cerebral hemorrhage, the NIHSS score of pre-treatment and 7 days post-treatment of the rest patients were 12.2±3.27 and 9.4±3.78 respectively, which achieved signiifcant statistic difference (P=0.04). In terms of the daily life capability, compared to 7 days after thrombolysis, BI score at 90 d was slightly improved and there was no signiifcant difference (62.5±27.23vs 47.5±27.84,P=0.13). The mRS scoce at 90 d was better than that at 7 d, but there was no signiifcant difference (4±0.82vs 3±0.82,P=0.09). Conclusion The intravenous thrombolysis treatment of acute ischemic stroke in the expanded time window under the guidance of multimode CT can promote the vessel recanalization, neural function recovery as well as daily activity restoration.
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