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。

Changes of CT Perfusion Imaging in Patients with Hyperacute Cerebral Infarction after Thrombolytic Therapy

Objective To investigate the changes of computed tomography perfusion imaging（CTPI） in patients with hyperacute cerebral infarction before and after thrombolytic therapy. Methods Forty-five patients with acute cerebral infarction within 6 hours after onset were randomly divided into thrombolytic group and control group. CTPI was performed on all patients before and after thrombolytic therapy in thrombolytic group, and to observe the changes of relative cerebral blood flow（rCBF）, relative cerebral blood volume（rCBV） and relative mean transit time（rMTT） on ischemic area, and to evaluate the changes of neurological function deficit scale before and after thrombolytic therapy. Compared these results between thrombolytic group and control group. Results Abnormal perfusion changes corresponding to clinical symptoms were all found in two groups, including CBF and CBV decreased, MTT delayed, which indicate there was an ischemic penumbra. Follow-up CTPI showed that the cerebral perfusion improved in most cases of thrombolytic group, there was no significant difference of rCBF and rCBV on infarction core compared to that before thrombolytic（P〉0.05）, the rCBF was significantly increased（P〈0.01）and rMTT was significantly decreased（P〈0.01）on ischemic penumbra after thrombolytic therapy. The rCBF and rCBV were significantly decreased and rMTT was significantly increased on ischemic penumbra in control group after routine therapy（P〈0.01）. After therapy, the rCBF and rCBV of ischemic penumbra were significantly increased and rMTT was significantly decreased in thrombolytic group than that in the control group（P〈0.01）. Improvement of national institutes of health stroke scale（NlHSS）in thrombolytic group was higher than that in control group. Conclusion The rCBF is increased and rMTT is decreased in patients with hyperacute cerebral infarction after thrombolytic therapy, and the NIHSS is decreaed.