多模式磁共振指导下的静脉溶栓治疗急性脑梗死的临床分析

目的探讨多模式MRI指导下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疗效和安全性。方法选择符合NINDS试验溶栓标准的CT阴性的40例急性脑梗死患者进行多模式MRI检查,筛选出符合溶栓标准的14例脑梗死患者,给予rt-PA0.9mg/kg静脉溶栓治疗,采用美国国立卫生研究院卒中量表评分(NIHSS)、Barthel指数(BI)及90天改良Rankin评分(mRS),评定溶栓治疗前与治疗后的神经功能。结果14例溶栓患者溶栓治疗后NIHSS评分24h(6.42±5.38)分,溶栓治疗后21天(3.64±3.05)分,溶栓治疗后90天(0.86±1.17)分;14例患者溶栓治疗前BI评分(18.93±6.26)分,溶栓治疗后21天(50.36±35.22)分,溶栓治疗后90天(88.93±13.21)分,均较溶栓治疗前明显升高,差异有统计学意义(P<0.01)。结论静脉rt-PA(0.9mg/kg)溶栓治疗发病4.5h之内的急性脑梗死是有效安全的;多模式MRI有助于选择从溶栓中获益并剔除那些存在高度出血性转化的患者。

Multi-modality magnetic resonance imaging-guided intravenous thrombolysis in acute cerebral infarction

Objective To evaluate the efficacy and safety of multi-modality MRI-guided intravenous thrombolysis in treatment of acute cerebral infarction.Methods A total of 40 patients with acute cerebral infarction were enrolled.All patients showed normal CT scan and met NINDS thrombolysis criterion.They received scanning by multi-modality MRI to assess risks and potential benefits of thrombolysis.Fourteen patients who had no thrombolysis contraindication were administrated with intravenous recombinant tissue plasminogen activator(rt-PA,0.9 mg/kg).The assessment using National Institutes of Health Stroke Scale(NIHSS)score and Barthel Index(BI)was made before and after treatment.Modified Rankin's Score(mRS)on 90th day was also assessed.Results Fourteen patients received rt-PA therapy.Their NIHSS score was(6.42±5.38)at 24 h,(3.64±3.05)and(0.86±1.17)on 21st day and 90th day after thrombolytic therapy respectively.Their BI score was(18.93±6.26)before therapy,(50.36±35.22)and(88.93±13.21)on 21st day and 90th day after thromolytic therapy respectively.These scores significantly decreased compared with the score before treatment(P<0.01).Conclusion Intravenous thrombolysis with rt-PA within 4.5 hours after symptom onset for acute cerebral infarction is safe and effective.Multi-modality MRI is helpful to choosing the patients who may be benefited from thrombolysis therapy and excluding the patients who are at risk of bleeding after thrombolysis.