头颅CT灌注成像指导下脑梗死溶栓观察

目的观察头颅CT灌注成像（CTP）指导下静脉溶栓治疗急性脑梗死的时机选择。方法采用开放性非随机的研究方法。18例发病3～6h临床诊断为脑梗死的患者，行CTP检查，有影像学改变且有缺血半暗带者进行溶栓治疗。评定病灶中心、病灶周边、周围正常脑组织相对脑血流量（rCBF）、相对脑血容量（rCBV）及平均通过时间（MTT）。比较溶栓前、溶栓后2h、24h、7d、90d NIHSS的变化；溶栓后7h、90h Bather指数（BI）、mRS的变化。结果CTP检查，18例病人均出现灌注异常，病灶中心区域与周边区比较差异有统计学意义（P〈0．05）。溶栓后2h、24h、7d NIHSS评分与溶栓前比较差异无统计学意义（P〉0．05），溶栓后90d NIHSS评分与溶栓前比较差异有统计学意义（P〈0．05）。溶栓后7d BI、mRS与溶栓前比较差异无统计学意义（P〉0．05），溶栓后90d BI、mRS与溶柃前比较差异有统计学意义（P〈0．05）。结论CTP可以帮助选择病人，在有影像学支持的前提下，适当扩大溶栓时间窗，在发病6h内予重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗安全有效。

Timing of thromobolytic therapy for acute cerebral infarction under guidance of CT perfusion imaging

Objective To observe timing of IV thromobolytic therapy for acute cerebral infarction under guidance of CT perfusion （CTP） imaging. Methods In this open non-randomized study, CTP was performed in 18 patients who were clinically diagnosed with cerebral infarction within 3 - 6 h of onset. Thrombolytic therapy was initiated in those who presented with imaging changes accompanied with penumbra. Regional cerebral blood flow （rCBF）, regional cerebral blood volume （rCBV） and mean transit time （MTT） in the center and periphery of the focus and around the normal brain tissue were evaluated. NIHSS before thromobolytic therapy and at 2 h, 24 h, 7 d and 90 d, and BI and mRS at 7 h and 90 h after thromobolytic therapy were compared. Results CTP showed that abnormal perfusion occurred in all 18 patients, and the difference between the center and periphery of the focus was statistically significant （P 〈 0.05）. There was no significant difference in NIHSS at 2 h, 24 h and 7 d after thromobolytic therapy as compared with that before thromobolytic therapy （P〉0.05）, while there was significant difference in NIHSS at 90 d after thromobolytic therapy as compared with that before thromobolytic therapy （P〈0.05）. There was no significant difference in BI and mRS at 7d after thromobolytic therapy as compared with those before thromobolytic therapy （P〉 0.05）, while there was significant difference in BI and mRS at 90 d after thromobolytic therapy as compared with those before thromobolytic therapy （P〈0.05）. Conclusions Brain CTP can help choose opportunity of intravenous thromobolysis therapy in cerebral infarction. With the imaging support, the time window of thromobolytic therapy could be expanded properly. Administration of rt-PA within 6 h of onset of acute cerebral infarction is safe and effective for thrombolytic therapy.