评估急性脑梗死静脉溶栓治疗后CT灌注变化及疗效

目的 利用CT灌注成像（CTPI）评价重组组织型纤溶酶原激活剂（rt-PA）治疗急性脑梗死疗效。方法 根据CTPI检查存在缺血半暗带与否，将100例发病6 h内急性脑梗死患者分别纳入观察组（n=56）或对照组（n=44），均给予rt-PA治疗。比较治疗前后CTPI梗死区域脑血容量（CBV）、脑血流量（CBF）和平均通过时间（MTT）；检测血栓相关因子水平，评价神经功能缺损和日常生活能力改善情况。结果 治疗后观察组梗死核心区和缺血半暗带区CBV和CBF较治疗前明显增加，MTT明显降低（P均<0.05），且观察组CBV和CBF均明显高于对照组（P均<0.05）。治疗后观察组血栓相关因子水平均降低（P<0.05），NIHSS评分和Barthel指数（BI）明显改善，且改善程度均优于对照组（P<0.05）。结论 CTPI指导rt-PA静脉溶栓治疗能明显改善缺血半暗带脑组织灌注，降低血栓形成风险，减轻神经功能缺损，提高日常生活能力。

Evaluation on CT perfusion imaging parameters and therapeutic effect of intravenous thrombolysis in patients with acute cerebral infarction

Objective To explore the therapeutic effect of recombinant plasminogen activator (rt-PA) in treatment of acute cerebral infarction using CT perfusion imaging (CTPI). Methods Totally 100 patients with acute cerebral infarction within 6 h of onset were divided into observation group (presence of ischemic penumbra,n=56) or control group (without ischemic penumbra, n=44) according to CTPI. All patients were treated with rt-PA. After treatment, CTPI was used to evaluate perfusion in the infarcted area. Plasma thrombosteroid-related factor level was tested, and the improving of neurological deficits and activities of daily living were evaluated. Results The cerebral blood volume (CBV) and cerebral blood flow (CBF) values in the infarct area of observation group significantly increased after treatment (all P<0.05), and the mean transition time (MTT) value was significantly lower (all P<0.05). After treatment, CBV and CBF values of observation group were significantly higher than those of control group (both P<0.05). The plasma thrombosteroid-related factor level decreased (P<0.05). NIHSS score and Barthel index (BI) score of observation group were significantly improved after treatment, also better than those of control group (both P<0.05). Conclusion Under the guidance of CTPI, rt-PA intravenous thrombolysis can significantly improve the brain tissue perfusion in ischemic penumbra, reduce the level of thrombus-related factors and alleviate brain tissue damage and neurological deficits.