CT灌注成像对急性缺血性脑卒中静脉溶栓治疗的安全性和有效性评价

摘要

Objective: To explore the guiding role of CT perfusion imaging in the safety and efficacy of intravenous thrombolytic therapy for acute ischemic stroke. Methods: 75 patients with acute middle cerebral artery ischemic stroke (6h) admitted in our hospital from October 2016 to December 2017 were selected as the subjects. The CBF ratio of 35 cases underwent CTP examination ranged from 0.20 to 0.35, suggesting reversi-ble ischemia penumbra. The remaining 40 cases were examined by CTP without ischemic penumbra. The two groups were treated with rt-PA thrombolytic therapy. The bleeding conversion rate, mortality rate, NIHSS score and Barthel index score of 24h, 7d, 30d and 90d after thrombolysis in two groups were compared. Re-sults: There were 1 case of hemorrhage conversion within 48 hours after thrombolytic therapy in IP group and 4 cases of hemorrhage conversion within 48 hours after thrombolytic therapy in no IP group,there were signifi-cant differences (P＜0.05).There were no deaths in IP group after thrombolytic therapy, and there were 1 deaths in 14d after thrombolytic therapy in group IP, no significant difference (P＝0.095).NIHSS scores and Barthel index scores after 24h, 7d, 30d and 90d after treatment in CTP group were better to control group and the difference was statistically significant ( P＜0.05) . Conclusion: In the thrombolytic therapy of patients with acute ischemic stroke, according to the results of CTP examination, it is important to predict the risk of sec-ondary hemorrhage after thrombolytic therapy, which is of great significance to the improvement and prognosis of neural function defects.%目的:探讨CT灌注成像对急性缺血性脑卒中静脉溶栓治疗的安全性和有效性的指导作用.方法:选择2016年10月至2017年12月间发病6h 内大脑中动脉急性缺血性脑卒中患者75 例为研究对象,35例行CTP 检查CBF比值为0.20～0.35,提示有可逆性缺血半暗带,其余40 例行 CTP 检查无缺血半暗带,两组均给予rt-PA 溶栓治疗.对比两组溶栓后24h、7d、30d、90d 的出血转化率及死亡率、NIHSS评分与Barthel指数评分.结果:存在IP 组溶栓治疗后48h 内出血转化1 例,无IP 组溶栓治疗后48h内出血转化4例,存在显著性差异(P＜0.05).存在 IP 组溶栓后无死亡病例,无 IP 组溶栓后14d内死亡1例,无显著性差异(P＝0.095). CTP 组溶栓治疗后 24h、7d、30d、90d 时的 NIHSS 评分与Barthel指数评分均优于对照组,差异具有统计学意义(P＜0.05).结论:在急性缺血性脑卒中患者的溶栓治疗中,依据CTP 检查结果指导制定个性的治疗方案,预测溶栓治疗后继发性出血的风险,对于神经功能的缺损的改善和预后均具有重要意义.