CT灌注成像指导重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死临床观察

摘要

①目的探讨CT灌注成像（CTP）检查指导的重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗急性脑梗死的有效性和安全性。②方法选取发病9h内急性脑梗死患者29例，经患者或家属签署知情同意书后行CTP、CTA检查，对存在缺血半暗带且同意rt-PA静脉溶栓治疗的10例患者给予rt-PA 40mg静脉溶栓治疗。记录溶栓前、溶栓后2h、24h、10d、30d NIHSS评分及溶栓前、溶栓后30dBarthel指数评分，并进行比较，复查头颅CT，监测并发症。③结果纳入的10例患者治疗前 NIHSS 评分为（10．90±4．04），溶栓治疗后2、24h、10、30d NIHSS评分分别降至（6．90±3．60）、（6．70±4．11）、（4．10±3．60）、（3．20±3．19），不同时间点NIHSS评分差异有统计学意义。溶栓前Barthel指数评分为（38．50±22．24），溶栓后30dBarthel指数评分为（78．53±30．00），两者比较差异有统计学意义。发生牙龈出血1例，无颅内出血、再闭塞及死亡病例，CT复查8例患者显示病灶较CTP低灌注区明显缩小，2例无明显变化。④结论 CTP指导的 rt-PA静脉溶栓治疗安全有效，有助于筛选适合溶栓的患者，并能扩大治疗的时间窗。%Objective To evaluate efficiency and safety of CT perfusion -based intravenous thrombolysis with recombinant tissue plasminogen activator ( rt-PA) in acute cerebral infarction .Methods 29 patients within 9 hours after symptom onset for a-cute cerebral infarction were enrolled in the study .After patients or relatives signed informed consent , they were scanned by CTP and CTA.10 patients with penumbra who agreed to accept rt -PA thrombolytic therapy were administrated with rt -PA 40mg.The NIH-SS was used to evaluate the recovery of neurological functions before , and 2 hours, 24 hours, 10 days and 30 days after thrombolytic therapy.A comparison of the Barthel Index (BI) was made 30 day after treatment.CT was also re-examined.The adverse effect and complication were monitored .Results 10 patients who met the CTP thrombolytic criterion and accepted rt -PA thrombolytic therapy were evaluated.The NIHSS score before, and 2 hours, 24 hours ,10 days and 30 days after rt-PA treatment was (10.90 ± 4.04), (6.90 ±3.60), (6.70 ±4.11), (4.10 ±3.60), (3.20 ±3.19), The improvement of NIHSS was significantly difference between before and after thrombolytic therapy .BI score before treatment was (38.50 ±22.24), and increased to (78.53 ±30.00) at 30d after treatment, and statistical differences were also found .Re-infarction and cerebral hemorrhagic were not seen and no death occurred .Among the 10 patients undergone CT reexamined , 8 patients'infarction areas were diminution obviously and 2 pa-tients'were remained .Conclusion CTP-based intravenous thrombolysis with rt -PA is safe and effective for patients with acute cerebral infarction , CTP is helpful to assess the patients who may obtain benefit from intravenous thrombolytic therapy and may ex -pand the time window .