目的:对比CT与多模式MRI指导下缺血性脑卒中静脉溶栓治疗后出血转化的差异,明确多模式MRI指导溶栓的安全性.方法:回顾分析2009年6月-2011年10月期间接受静脉重组组织型纤溶酶原激活剂(rtPA)溶栓治疗的缺血性脑卒中患者资料,包括性别、年龄、既往史、溶栓时间、基线NIHSS、血压、血糖、电解质、凝血谱和心电图,以及溶栓后CT与MRI检查等,按照中国缺血性卒中亚型(CISS)标准予以病因分组.结果:共113例患者接受静脉rtPA治疗,平均年龄:(66±12)岁,男性74例,占65.5％,溶栓前美国国立卫生院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分12.4±6.5,发病至溶栓时间:(259.7±131.7)min；溶栓后24h复查发现,34例(30.1％)出现溶栓后出血转化,其中9例(8％)为症状性出血.Logistic回归分析发现,多模式MRI指导下溶栓后的出血转化风险明显减少(OR=0.599,95％CI:0.373～0.962；P=0.034).结论:多模式MRI指导溶栓相对于CT筛查,在静脉rtPA溶栓治疗后显示更低的出血转化率.%Objective: To compare the safety of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) in ischemic patients under the guidance of CT and multi-mode MRI. Methods: The clinical,laboratory,and radiologic data from 113 consecutive hyperacute ischemic patients who received intravenous rtPA therapy from June 2009 to October 2011 was retrospectively reviewed. The rate of hemorrhagic transformation ( HT) and the clinical outcome between CT and multi-mode MRI was compared. Etiological subgroups were classified according to Chinese ischemic stroke subclassification ( CISS) . Results: Among 113 patients treated with intravenous rtPA,the mean age was 66 ± 12 years,74 rn(65. 5% ) were man,the pretreatment National Institutes of Health Stroke Scale score (NIHSS) was 12. 4 ±6.5, and time from symptom onset to therapy was 259. 7 ±131.7 min. Postlytic radiological HT was found in 34 patients (30. 1%). Symptomatic ICH occurred in 9 patients (8%). Logistic regression analysis suggested that multi-mode MRI was an independent predictor of reduced risk of HT. Conclusion: The risk of hemorrhagic complications is lower in patients receiving intravenous thrombolytic therapy with rtPA guided by multi-mode MRI than those guided by CT scan.
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