脑卒中患者静脉溶栓治疗采用纤溶酶原重组组织型激活剂与早期影像学征象改变的相关性研究

研究脑卒中患者CT灌注（CTP）在辅助纤溶酶原重组组织型激活剂（rt-PA）静脉溶栓治疗中的临床意义。方法：选取我科2010年1月至2013年1月因急性脑卒中入院治疗的患者共58例，根据CTP 提示是否存在缺血半暗带（脑血流量CBF比值介于0．2-0．6之间）分为实验组和对照组。对照组予以rt-PA静脉溶栓，实验组在对照组的基础上，予以CTP 辅助溶栓。对比实验组患者溶栓前及溶栓后24h、7d的CTP 各参数。对比两组患者溶栓前及溶栓后24h、7d的NIHSS评分；对比两组患者溶栓后14d时的临床疗效及治疗期间不良反应。结果：实验组患者治疗后24h、7d的CBF、CBV灌注量均显著高于前一时间节点，而CBF、CBV和TTP 面积均显著低于前一时间节点，P＜0．05。实验组患者治疗后24h、7d的rCBF和rCBV均显著高于前一时间点，P＜0．01。两组患者治疗后24h、7d的NIHSS评分均显著低于前一时间节点，P＜0．01；实验组治疗后24h、7d的NIHSS评分均显著低于同一时间节点的对照组，P＜0．01。实验组的临床疗效显著优于对照组，P＜0．05。两组患者不良反应发生率无显著差异，P＞0．05。结论：CTP 辅助静脉溶栓治疗对于脑卒中患者具有一定的临床意义。

The Correlation between Stroke Patients Using Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator and Early Radiographic Signs

To analyze correlation between stroke patients using intravenous thrombolysis with recombinant tissue plasminogen activator and early radiographic signs of CTP change .Method：58 pa-tients with stroke from Jan .2010 to Jan .2013 in our hospital were selected and divided into experimental group and control group according to CTP prompted the existence of ischemic penumbra （ CBF cerebral blood flow ratio between 0.2-0.6） .The control group received rt-PA intravenous thrombolysis .The experimental group was treated with rt-PA intravenous thrombolysis plus CTP .CTP parameter, rCBF and rCBV of the ex-perimental group before and 24h, 7 days after thrombolysis were compared .The NIHSS score in patients of two groups before and after 24h, 7 days thrombolysis was compared .The thrombolytic efficacy and adverse reactions in two patients of groups were also compared .Result：After the 24h, 7 days of thrombolysis ,CBF and CBV were significantly higher than the previous time node , and CBF , CBV and TTP area were signifi-cantly lower than the previous time node , P 〈0.05.After 24h, 7d of thrombolysis , rCBF and rCBV were sig-nificantly higher than the previous time point , P 〈0.01.The NIHSS scores after 24h, 7d of treatment were significantly lower than the previous time node , P 〈0.01.The NIHSS scores after 24h, 7d of treatment were significantly lower in the experimental group than that in the control group at the same time node , P 〈0.01. The clinical efficacy of the experimental group was significantly better than that in the control group , P 〈0. 05.Two groups of patients the incidence of adverse reactions was no significant difference , P〉0.05.Conclu-sion：CTP assisted intravenous thrombolytic therapy for stroke patients have clinical significance .