遗忘型轻度认知损害和非痴呆血管性认知损害的局部脑血流量

目的 探讨遗忘型轻度认知损害(aMCI)和非痴呆血管性认知损害(VCI-ND)的局部脑血流量(rCBF)改变的特征.方法 健康中老年人16名,aMCI组患者10例,VCI-ND组患者12例,年龄在50～80岁,教育程度均在初中毕业及以上,全部完成头颅CT或MRI检查.应用Xe-CT技术定量测定38例研究对象脑不同部位的rCBF.结果 (1)静息状态健康中老年人(NC)组脑不同部位的rCBF分布情况:由高到低分别为基底节核团(76.4±8.6)ml·100 g-1·min-1、皮质(48.0±7.1)ml·100 g-1·min-1和白质(20.5±1.7)ml·100 g-1·min-1.(2)NC组、aMCI组和VCI-ND组患者的rCBF表现比较:aMCI组颞、顶、枕叶的rCBF值呈一定趋势的减少,VCI-ND组额叶的rCBF值呈一定趋势的减少,而VCI-ND组rCBF下降最明显的部位集中在白质区域[(17.7±2.3)ml·100 g-1·min-1,F=5.740,P=0.002],从深度看覆盖了脑室旁白质和皮质下深部白质两部分,从长度看覆盖了白质的前后区域.3组基底节区核团包括尾状核、豆状核和丘脑的rCBF值比较差异无统计学意义.结论 aMCI和VCI-ND的rCBF值的差异反映了两者在病理机制方面的差异.     

创伤性脑缺血的研究进展

通常在脑组织代谢正常状态下,局部脑血流(rCBF)低于20ml·100g-1·min-1.,脑组织就处于缺血半暗带状态,神经元呈可逆性损伤,表现为细胞间信号传递停止,细胞有氧代谢降低,泵功能抑制,神经细胞去极化,无氧酵解增加;当rCBF低于10ml·100g-1·min-1时,ATP合成停止,泵功能衰竭导致脑组织不可逆坏死[1].     

进展性脑卒中15例临床及脑血流特征

目的 通过研究伴有血管狭窄的进展性脑卒中患者的临床资料及脑血流情况,总结其临床特征,并探讨病情进展与脑血流量变化间的关系.方法 对15例有血管狭窄,符合前循环梗死的进展性脑卒中患者的临床资料进行分析总结,并应用Xe-CT检测患者病情进展过程中脑组织血流情况.结果 本组患者多以一侧肢体瘫痪起病(13例),病情进展较快,上肢瘫痪重于下肢(11例),梗死病灶多在分水岭区(10例).15例患者中有11例在病情进展过程中行脑血流量检测,示病灶周围存在较大面积的低灌注区(10 ml·100 g-1·min-1<脑血流量<20 ml·100 g-1·min-1).结论 伴有血管狭窄的进展性脑卒中患者有特征性的临床表现,狭窄血管所致的低灌注可能是导致病情进展的重要原因之一.     

局灶性脑缺血的脑保护

局灶性脑缺血多由脑血管严重的狭窄、痉挛或完全阻塞所致.一般认为局部脑血流量(rCBF)低于20 ml*100 g-1*min-1时即可出现脑缺血损害,脑缺血后由于局部脑组织缺血缺氧,可造成局部脑水肿、兴奋性有毒物质释放、缺血周围去极化、炎症反应等,最终可造成神经元坏死或凋亡,形成梗死.针对脑缺血后发生的反应,及时给予脑保护措施,对缩小梗死面积,改善预后都有极为重要的意义.现将这些方面的研究进展综述如下.     

不同类型偏头痛局部脑血流量变化的研究

目的检测有先兆及无先兆的偏头痛脑局部血流量(rCBF)的变化。方法研究对象共分4组:分别为无先兆的偏头痛组40例(M组)、有先兆的偏头痛25例(MA组)、肌紧张型头痛25型(TH组)以及对照组(C组)40名,用133Xe吸入法测定三组头痛及正常对照组的脑局部血流量。结果无先兆偏头痛组(M)平均脑局部血流量(71.04±12.01)ml/100 g脑组织/分,而有先兆偏头痛MA组平均脑局部血流量(55.27±10.13)ml/100 g脑组织/分,肌紧张头痛(TH)组平均脑局部血流量(60.82±7.64)ml/100 g脑组织/分,正常对照(C)组平均脑局部区域血流(59.96±7.63)ml/100 g脑组织/分,经统计学处理,F=12.01,P<0.001,M组平均rCBF明显高于正常对照组及肌紧张头痛组,而MA组的rCBF明显低于常对照组及肌紧张头痛组。TH组rCBF与正常对照组相比无明显差异(P>0.05)。结论无先兆偏头痛组平均脑局部血流量呈弥漫性高血流量状态,而有先兆偏头痛组明显低于正常对照组(P<0.001),尤以后枕部血流量降低更为明显。肌紧张头痛组rCBF与正常对照组相比无明显差异(P>0.05)。     

单侧颈内动脉或大脑中动脉狭窄患者脑血管储备力的评估

目的 采用单光子发射计算机断层扫描（SPECT）结合二氧化碳（CO2）吸入试验评价单侧颈内动脉（ICA）或大脑中动脉（MCA）狭窄或闭塞患者的脑血管储备力（CVR）.方法 分别在静息状态下及CO2吸入试验后,对43例单侧ICA或MCA狭窄或闭塞患者行SPECT检查.设定12个感兴趣区（ROI）,左右对称各6个,计算各ROI的平均局部脑血流量比值（rCBF％）,比较正常侧与患侧rCBF％的差值及CO2吸入试验前后各ROI的rCBF％变化.结果 43例患者检测516个ROI,对CO2反应存在4种情况：①静息状态下和CO2吸入试验后,各ROIrCBF％均正常241个;②静息状态时ROI rCBF％正常,CO2吸入试验后减低190个;③静息状态时ROI rCBF％减低,CO2吸入试验后减低更为显著25个;④静息状态时ROI rCBF％减低,CO2吸入试验后较前升高65个.另43例患者中有13例（30.2％）CVR正常,其中单侧ICA狭窄患者7例,单侧MCA狭窄患者6例.结论 SPECT ROI rCBF％提示单侧ICA或MCA狭窄或闭塞患者脑血管CVR存在4种不同情况;单侧ICA或MCA狭窄或闭塞的患者中存在CVR正常者.     

画钟测验的评分方法探讨

目的 编制和验证画钟测验(CDT)新的评分方法.方法 对188名健康中老年人、170例轻度认知障碍(MCI)患者和81例轻度阿尔茨海默病(AD)患者进行CDT等一系列神经心理测验.CDT 30分法包括先锚定12-3-6-9 4个点,称为"30分法-A",共4分;反映画钟结果的其余13项,称为"30分法-C",共26分,总分30分.38例被试者完成氙-CT(Xe-CT)检查,定量测量脑26个区域的局部血流量(rCBF).结果 CDT 30分法的14个项目分与总分的相关系数r=0.48～0.71,均有显著的相关性(P＜0.01)."30分法-C"与空间知觉和执行功能指标的相关性较大(r=0.58～0.64),而"30分法-A"与记忆指标的相关性较大(r=0.67)."30分法-A"≤2分,识别MCI的敏感性为70.6%,特异性为73.9%,"30分法-C"≤17分,识别MCI的敏感性为38.2%,识别轻度AD的敏感性为75.3%,特异性为75.9%.CDT与Xe-CT检测的rCBF的关系:"30分法-A"和"30分法-C"的回归方程中,入选的自变量分别为左额叶下区和右白质区.结论 "30分法"A和C两部分具有不同的意义,"30分法-C"可用于识别AD,而"30分法-A"有助于MCI的识别.     

大脑中动脉狭窄或闭塞患者侧支循环320排计算机断层扫描血管成像联合脑灌注成像研究

目的   利用320排计算机断层扫描血管成像（computed tomography angiography,CTA）及脑灌注成像（computed tomography perfusion imaging,CTP）探讨单侧大脑中动脉（middle cerebral artery,MCA）重度狭窄或闭塞的急性缺血性卒中患者侧支循环与脑灌注的关系。 方法  对72例单侧MCA重度狭窄或闭塞的急性缺血性卒中患者行头部320排CTA及CTP检查,根据有无侧支循环分为2组,对2组CTA和CTP情况进行分析比较。 结果  共入组72例患者,有侧支循环组58例,无侧支循环组14例。有侧支循环组38例（65.52%）MCA闭塞,无侧支循环组中5例（35.71%）MCA闭塞,两组差异有显著性（P=0.041）。有侧支循环组脑灌注代偿率高于无侧支循环组（68.97% vs 21.43%,χ2＝10.595,P＝0.001）;在CTP异常的68例患者中,有侧支循环者54例,无侧支循环者14例,有侧支循环组患侧的脑血容量［35.00（29.92,41.13）ml/100?g vs 26.25（18.23,37.18）ml/100?g］及脑血流量［（2.39±0.73）ml/100?g·min vs （1.75±0.72）ml/100?g·min］高于无侧支循环组,P分别为0.007和0.040。但2组患侧平均通过时间（mean transit time,MTT）及平均达峰时间（time to peak,TTP）差异无显著性。 结论  320排CTA联合CTP检查显示急性缺血性卒中患者中有侧支循环者脑灌注代偿率高,而且其脑血容量和脑血流量均高于无侧支循环者。     

人血浆CXC趋化因子配体16水平与颅内外动脉狭窄的关系

目的 探讨人血浆CXC趋化因子配体16（CXCL16）与颅内外动脉狭窄的关系。方法 2012年1月至2014年1月收治脑动脉狭窄致缺血性脑血管病患者100例,其颅内动脉狭窄54例,颅外动脉狭窄18例,颅内外动脉狭窄28例;轻度狭窄23例,中度狭窄35例,重度狭窄42例。另选择脑动脉正常健康体检者15例作为对照。酶联链免疫吸附法检测血浆CXCL16浓度。结果 与对照组CXCL16浓度[（1.15±0.11）ng/ml]比较,脑血管狭窄组血浆CXCLl6浓度[（3.25±0.24）ng/ml]显著升高（P<0.05）;单纯颅内动脉狭窄组、单纯颅外动脉狭窄组、颅内外动脉狭窄组比较,血浆CXCLl6浓度差异不具有统计学意义（P>0.05）;轻度脑动脉狭窄组、中度脑动脉狭窄组、重度脑动脉狭窄组CXCLl6浓度分别为[（3.02±0.11）ng/ml],[（3.17±0.07）ng/ml]和[（3.36±0.12）ng/ml],逐渐升高（P<0.05）,均明显高于对照组（P<0.05）。结论 人血浆CXCL16水平可能与脑血管狭窄有关,对脑动脉狭窄程度和脑血管事件的发生可能有一定的辅助预测作用。     

阿尔茨海默病患者局部脑血流量及脑血管反应性研究

目的 了解阿尔茨海默病患者(AD)相对正常老年人局部脑血流量(rCBF)以及脑血管反应性(CVR)的变化特征及规律.方法 应用动脉自旋标记核磁共振技术(ASL)首先定量测定静息状态下两组病例rCBF,然后分别吸入5％的CO2各1min,再次测定rCBF,并计算其增加率以代表CVR.结果 相比对照组,AD组在双侧额叶、颞叶、顶叶的皮质及皮质下均有显著性的rCBF降低,但仅在双侧额叶皮质有显著性的CVR下降.结论 广泛的皮质及皮质下rCBF降低以及双侧额叶皮质CVR的下降可能是AD的一个重要临床客观指标.     

Threshold of regional cerebral blood flow for infarction in patients with acute cerebral ischemia

Threshold of regional cerebral blood flow (rCBF) for cerebral tissue survival in relation to time was studied in patients with acute cerebral ischemia with xenon-enhanced computed tomography (XeCT). Case 1: A 58-year-old man with right hemiparesis, total aphasia and a high intensity area of 1 cm 2 in the left insula on diffusion weighted image underwent XeCT CBF study before and after intra-arterial local thrombolytic therapy (IALT) on the occluded middle cerebral artery (MCA) 4 hours and 7 hours after stroke onset, respectively. Case 2: A 65-year-old woman with recurrent transient ischemic attacks (TIAs) caused by severe stenosis of the left MCA underwent XeCT CBF study 5 hours after onset of the last attack. XeCT was conducted by 5-min wash-in method. In Case 1 the rCBF in the pre-IALT MCA territory was 4 to 19 ml/100 g/min. The area where rCBF in the post-IALT increased to above 15 ml/100g/min were saved, but the other area where it remained in the 9 to 14 ml/100 g/min evolved into infarct on subsequent CT scan/MR (magnetic resonance) imaging. The patient was discharged with only mild motor dysphasia. In Case 2 the left corona radiata showed rCBF of 7 ml/100 g/min and this area evolved into infarct on MR imaging. The patient was discharged home with right hemiparesis. Our results showed validity of the rCBF threshold in acute cerebral ischemia reported by Jones et al. Residual rCBF in the acute stage of cerebral ischemic stroke can predict the fate of the lesion.     

森田疗法在轻-中度急性缺血性卒中治疗中的应用研究

目的 探讨森田疗法对轻-中度急性缺血性卒中患者康复、住院时间、住院费用的影响.方法 将NIHSS评分为＜15分的70例中度脑卒中患者随机分为两组,分别给予森田疗法与常规疗法联合治疗(心理干预组20例)和单用常规疗法治疗(未心理干预组50例).比较两组患者入院时和出院前的NIHSS、mRS、BI、住院天数、住院费用上的差别.结果 与常规治疗相比,对轻-中度急性缺血性卒中用森田疗法进行心理治疗可以使患者平均住院天数明显缩短[心理干预组:(10.5士2.7)d,未心理干预组:(15.4±2.1)d,(P＜0.05)],平均住院费用降低[心理干预组:(14 885.5士3 687.5)元,未心理干预组:(22 773.4±4 221.7)元,(P＜0.05)],而对△NIHSS、△mRS、△BI评分无明显影响.结论 对脑卒中患者进行心理干预,可以缩短其住院时间、减少住院费用、促进康复.     

颞浅动脉-大脑中动脉搭桥术治疗动脉粥样硬化性脑缺血13例报告

目的 探讨颞浅动脉-大脑中动脉搭桥术（superficial temporal artery-middle cerebral artery bypass,STA-MCA bypass）治疗动脉粥样硬化性脑缺血的疗效。方法 对北京天坛医院进行STA-MCA bypass治疗的13例经计算机断层扫描灌注成像（computertomography perfusion,CTP）评价存在低灌注的颈内动脉和（或）大脑中动脉粥样硬化性重度狭窄和（或）闭塞患者进行回顾性研究。通过手术中脑血管吲哚菁绿荧光造影和手术后数字减影血管造影（digital subtraction angiography,DSA）、计算机断层扫描血管成像（computer tomography angiography,CTA）等确定吻合血管通畅程度。比较手术前、后美国国立卫生研究院卒中量表（National Institutes ofHealth Stroke Scale,NIHSS）评分、改良的Rankin量表（modified Rankin Scale,mRS）评分及CTP参数值。结果 13例患者中,男11例、女2例,11例行STA-MCA bypass,2例行STA-MCA bypass联合脑-硬脑膜-动脉贴敷术,吻合血管血流通畅。手术后3个月mRS评分较术前下降（0.92±0.76 vs 2.38±1.26,P =0.001）。手术侧比非手术侧MCA供血区域CTP参数绝对值的比较,手术前和术后15 d内相对脑血流量（relative cerebral blood flow,RCBF）、相对平均通过时间（relative mean transit time,RMTT）及相对达峰时间（relative time to peak,RTTP）分别为0.71±0.13 vs 1.00±0.25、2.53±1.32 vs 1.48±0.94和1.20±0.11 vs 1.07±0.12,P =0.002、0.036和0.015）。手术后3～10个月RTTP较术前下降（1.10±0.96vs 1.22±0.82,P =0.043）。13例患者在随访期间无死亡、无新的脑缺血事件发生。结论 对于CTP评价存在低灌注的动脉粥样硬化性脑血管重度狭窄或闭塞患者,STA-MCA bypass可能能够改善低灌注状态、减少缺血症状发作及预防卒中再发生;CTP可能成为简单可靠并有推广价值的评价手段。     

超早期溶栓治疗对缺血性卒中患者计算机断层扫描灌注成像的影响

目的 探讨超早期溶栓治疗对缺血性卒中患者计算机断层扫描（computed tomography,CT）灌注成像的影响。方法 选取发病6h内的急性缺血性卒中患者45例,随机分为溶栓组和对照组。于溶栓前、后行CT灌注成像检查,观察溶栓前后病变区相对脑血流量（relative cerebral blood flow,rCBF）、相对脑血容量（relative cerebral blood volume,rCBV）、相对平均通过时间（relative mean transit time,rMTT）的变化,于溶栓前、后进行美国国立卫生研究院卒中量表（national institutes of health stroke scale,NIHSS）评分,并与对照组比较。结果 两组患者CT灌注成像均发现与临床症状对应的脑灌注异常区,表现为CBF、CBV降低,MTT延迟,表明存在缺血半暗带。溶栓组大部分患者溶栓后脑灌注情况明显改善,梗死核心区rCBF、rCBV与溶栓前差异无统计学意义（P＞0.05）;缺血半暗带区rCBF值显著增加（P＜0.01）,rMTT值减小（P＜0.01）。对照组常规治疗后缺血半暗带区rCBF、rCBV值明显减低,rMTT增加（P＜0.01）。治疗后两组相比,溶栓组缺血半暗带区rCBF、rCBV值较对照组明显增加,rMTT值明显减少（P＜0.01）。溶栓组神经功能恢复比率明显高于对照组（P＜0.01）。结论 急性缺血性卒中患者溶栓后缺血半暗带区rCBF显著增加,rMTT减少,神经功能缺损评分明显降低。     

A dynamic concept of middle cerebral artery occlusion and cerebral infarction in the acute state based on interpreting severe hyperemia as a sign of embolic migration

The present study investigates the pathogenesis of focal cerebral hyperemia, its effect on brain tissue and discusses its pathophysiological and therapeutic importance in the light of interpreting severe hyperemia as a sign of arterial reopening probably due to embolic migration. Cerebral angiography, serial CT-scans and serial TC99 -scans were performed in a consecutive group of 73 patients with completed stroke all admitted to hospital within 3 days after stroke onset. When possible the regional cerebral blood flow (rCBF) was studied with the intracarotid Xe 133 injection method. Twenty-nine patients had evidence of middle cerebral artery (MCA) occlusion; rCBF was investigated in 24. Fourteen patients had either occlusion or severe internal carotid artery (ICA) stenosis; rCBF was not measured in these patients. Thirty patients had no angiographical evidence of MCA occlusion, ICA occlusion or severe ICA stenosis; rCBF was investigated in 24. Focal hyperemia was observed in 21 patients but exclusively in the group with evidence of MCA occlusion. Hence, these 21 patients are typical and representative for the group of patients with evidence of MCA occlusion. Hyperemia was found in infarcted as well as in non-infarcted tissue. Apparently, it is the severity of the initial ischemic episode and not the hyperemia that determines whether or not tissue necrosis develops. Interpreting severe hyperemia as a sign of arterial reopening and embolic migration (evidenced by partial reopening affecting only some MCA branches) reopening had occurred in about 1/3 of the patients with MCA occlusion before they were examined 1 to 4 days after stroke onset. Autopsy studies performed in 8 of the patients with MCA occlusion indicate that arterial reopening also takes place in many patients later on (7 of 8). According to this interpretation, hypothetical as it is, the changing position of the embolus is associated with partial or complete reperfusion leading to hyperemia in the initially ischemic brain tissue. The hemodynamic basis for appropriate therapy therefore may change from one day to the next in the acute state of stroke due to MCA occlusion.     

软脑膜侧支循环对症状性大脑中动脉 狭窄或闭塞患者卒中复发及死亡事件影响研究

目的 通过磁共振血管成像（magnetic resonance angiography,MRA）检查,研究不同途径的软脑膜动
脉（leptomeningeal anastomoses,LMA）代偿对症状性大脑中动脉（middle cerebral artery,MCA）狭窄或闭
塞患者1年内预后的影响。
方法 选取在首都医科大学附属北京天坛医院神经内科住院治疗的症状性MCA狭窄或闭塞患者,经
过MRA评价LMA代偿情况分为大脑前动脉（anterior cerebral artery,ACA）途径代偿组、大脑后动脉
（posterior cerebral artery,PCA）途径代偿组、双代偿途径组和无代偿组,据随访结果,对不同途径
LMA代偿组预后对比,了解不同途径LMA代偿对患者预后的影响。
结果 随访1年中有17例缺血性卒中复发事件,复发率为6.83%。共6例患者死亡,死亡率为2.4%。在4
组不同途径LMA代偿组间,缺血性卒中（χ2=7.824、P =0.0497）、总的不良事件（χ2=11.238、P =0.011）
存在显著差异。其中无代偿组卒中复发高于双代偿途径组（P =0.022）。在总不良事件方面,无代偿组
与双代偿途径组、无代偿组与ACA代偿途径组之间存在显著差异,P值分别为0.004和0.04。有代偿组
在缺血性卒中、总事件等方面均低于无代偿组（P值分别为0.021和0.003）;两组间脑出血、全因死亡
等方面无显著差异。
结论 良好的LMA可以有效减少症状性MCA狭窄或闭塞患者1年内缺血性卒中等不良事件的发生,但
对脑出血及全因死亡无影响。     

Comparison of different intravascular thread occlusion models for experimental stroke in rats

For the induction of ischemic strokes of varying sizes in rats, different types of threads were used to occlude the middle cerebral artery (MCA) in combination with or without the posterior communicating artery (PCOM) and the common carotid artery (CCA). During vessel occlusion brain tissue partial oxygen pressure (ptiO2) and regional cerebral blood flow (rCBF) were monitored using a combined ptiO2/laser Doppler flow probe. Following neurological assessment animals were sacrificed at 3, 8 and 24 h and the necrotic volume was measured on serial coronary slices. In another experimental group, rCBF was measured 1h post-insult with the iodo[14C]antipyrine method. Animals with selective MCA occlusion showed less reduction of ptiO2 and rCBF and smaller infarcts when compared with animals with combined occlusion of the MCA, CCA and PCOM. Both groups, selective MCA occlusion and combined occlusion of the MCA, CCA and PCOM, demonstrated a high reproducibility and low variability of stroke size. Relative growth of stroke size within 24 h was higher in animals with selective MCA occlusion. Therefore, the selective MCAO model may be advantageous for studies of neuroprotective strategies.     

血尿酸水平与缺血性脑卒中的相关性

目的探讨血尿酸水平与缺血性脑卒中之间的相关性。方法采用病例对照研究,选择2006-07—2011-03在我院神经内科住院的缺血性脑卒中患者177例（病例组）;对照组202例,为同期我院健康体检者。对所有纳入对象测定禁食12h后静脉血清尿酸值及其他生物化学指标,探讨血尿酸水平与缺血性脑卒中的关系。结果病例组血清尿酸水平（359.47±70.84）μmol/L显著高于对照组（310.26±76.35）μmol/L,2组比较差异有统计学意义（P〈0.01）。多因素Logistic回归分析显示,糖尿病、高血压、LDL-C及血尿酸是缺血性脑卒中发生的独立危险因素,血尿酸水平升高与缺血性脑卒中密切相关（OR=1.183,95%CI1.052～1.331;P=0.018）。结论缺血性脑卒中患者血尿酸水平显著升高,血尿酸与缺血性脑卒中发生密切相关,可能是其独立危险因素。     

Cerebral hemodynamics in adult ischemic-type patients with moyamoya disease compared with those of atherothrombotic middle cerebral artery occlusion]

We measured regional cerebral blood flow (rCBF) in adult ischemic-type patients with moyamoya disease and in patients with atherothrombotic middle cerebral artery occlusion (MCAO) to investigate cerebral hemodynamics in adult ischemic-type of moyamoya disease. In this study we measured rCBF and regional cerebrovascular response (rCVR) using acetazolamide by Xenon-enhanced CT. Our subjects consisted of 15 adult ischemic-type patients with moyamoya disease and 27 atherothrombotic stroke patients with proximal occlusion of the middle cerebral artery. The region of interest was conducted in the anterior cerebral artery, middle cerebral artery and posterior cerebral artery territories as well as basal ganglia regions. rCBF was preserved in all regions of patients with moyamoya disease. However, rCVR severely decreased in the anterior circulation territory in patients with moyamoya disease compared with those of MCAO. These results suggest that rCBF in the anterior circulation territory of adult ischemic-type patients with moyamoya disease is preserved by vasodilation of the cerebral arteries, while cerebral hemodynamic reserve capacity is severely reduced. The results indicated that basal moyamoya vessels are dilated. These findings may be one of the reasons why stroke occurs more frequently in adult than child patients with moyamoya disease.     

动静脉联合溶栓治疗大脑中动脉闭塞引起的急性缺血性脑卒中

目的研究动静脉联合溶栓治疗大脑中动脉闭塞引起的急性缺血性脑卒中的安全性和有效性。方法回顾分析我院采用静脉溶栓或动静脉联合溶栓病例23例。卒中严重程度采用NIHSS评分评估,CTA,MRA或全脑血管造影评估再通情况,溶栓治疗后72 h内观察溶栓后非症状性和症状性出血,临床预后通过改良RS评分进行评估。结果静脉溶栓组14例,动静脉联合溶栓组9例,两组患者入院后NISS评分无统计学差异,动静脉联合溶栓后大脑中动脉再通率明显高于静脉溶栓组(77.8 vs.28.6%,P=0.036),而术后出现症状性及非症状性颅内出血与静脉溶栓比较无明显差异,90 d达到mRS 0-2分患者比例与静脉组比较无统计学差异,联合溶栓组高于静脉组。结论与静脉溶栓比较,应用动静脉联合溶栓治疗大脑中动脉闭塞引起的急性缺血性脑卒中是一种安全、有效的方法。