目的 用多模式磁共振探讨影响急性脑梗死静脉溶栓治疗预后的解剖学因素. 方法 回顾性分析169例接受rtPA静脉溶栓治疗的急性小范围脑梗死患者的影像学资料. 以美国国立卫生研究院率中评分量表( National Institute of Health Stroke Scale, NIHSS)进行入院评分,以90 d时的改良Rankin量表(mRS)评分作为疗效指标,分析比较不同部位、不同干预间隔(OTT)( <270 min、≥270 min)情况下急性小范围脑梗死的愈后. 结果 (1)不同发病部位小范围梗死发病前NIHSS评分差异无统计学意义(P>0.05). 不同发病部位3个月后mRS评分差异有统计学意义(P<0.05),发病部位位于端脑及基底节区的患者显著疗效比例高于另外2组. (2)OTT对小范围梗死的预后影响比较差异无统计学意义(P>0.05). 结论 不同发病部位的小范围脑梗死愈后不同. 不同干预间隔对小范围梗死的预后没有显著影响.%Objective To investigate the anatomic factors affecting the prognosis of acute cerebral infarction ( ACI) with in-travenous thrombolytic therapy by using multimode MRI .Methods Photographic data of 169 ACI cases treated with rtPA intravenous thrombolytic therapy were retrospectively analyzed .With NIHSS used as the admission scores and mRS scores at day 90 as the curative effect index, analyses were made on the prognosis of small scale ACI at different parts and different intervention intervals (DII)(<270 min,≥270 min).Results (1) There were no significant differences in the NIHSS scores of the patients with small scale infarction at different affected sites (P>0.05).After 3 months, statistical significance could be seen in mRS scores at different affected sites (P>0.05).The proportion of obvious efficacy for the patients with the affected sites at end -brain and basal ganglion region was obviously higher than that of the other 2 groups.(2) Statistical significance could neither be seen in the effect of DII on the prognosis of small scale ACI (P>0.05).Conclusion Outcomes of different cerebral infarction were varied at different affected sites .Different interven-tion interval ( DII: <270 min,≥270 min) seemed to have no significant effect on the prognosis of the small area infarction .
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