目的 探讨临床-弥散加权成像不匹配(CDM)评价溶栓、降纤治疗急性脑梗死的价值.方法 发病3-6 h的急性脑梗死患者43例,入院后即行弥散加权成像(DWI)检查,并于治疗前行美国国立研究院卒中量表(NIHSS)评分.患者分为溶栓(20例)及降纤(23例)两组,每组患者再根据NIHSS评分及DWI检查结果分为CDM(+)及CDM(-)两亚组.于发病后第30天再次行NIHSS评分.结合CDM比较两种治疗方法改善患者神经功能缺陷的效果.结果 对于CDM(+)患者,溶栓治疗前后神经功能缺陷程度显示有显著改善；而降纤治疗前后神经功能缺陷程度未显示显著改善.而对于CDM(-)患者,溶栓或降纤治疗前后神经功能缺陷程度均未显改善.结论 CDM有助于指导临床进行急性脑梗死的选择性溶栓治疗,但不适于指导降纤治疗.%Objective To investigate the significance of clinical-diffusion mismatch (CDM) in evaluating the different therapice for acute ischemic stroke. Methods Diffusion weighted imaging (DWI) and NIHSS scoring were carried out in 43 patients with acute ischemic stroke( within 3-6 hour after onset) imrnedietly after admission and before treatment. The patients were assigned into two groups of A(20 cases,treated with thrombolysis) and B(23 cases,treated with defibrase). Each group was divided into two subgroups of CDM (+ ) and CDM (-) according to the National Institute of Health Stroke ScaleC NIHSS) score and DWL NIHSS was scored again for each patient 30 days after onset. The neurological improvements were compared between two groups. Results The neurological improvement was significant in CDM( + ) cases of group A, which was not in CDM( + ) of group B. The patients with CDM( -) in groups of A and B showed no significant neurological improvements. Conclusion CDM could be useful in guiding the selection for thrombolysis therapy, but was not suitable for directing the selection for defibrase therapy in the patients with acute ischemic stroke.
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