多模式MRI指导下超时间窗进展性脑梗死静脉溶栓临床研究

目的探讨超时间窗进展性脑梗死低剂量阿替普酶静脉溶栓疗效及安全性。方法多模式MRI指导下,选取焦作煤业集团中央医院2016-01—2018-11收治超时间窗(发病6~12 h)进展性脑梗死患者70例为研究对象,随机分为溶栓组35例及未溶栓组35例,未溶栓组给予常规治疗,溶栓组在常规治疗基础上低剂量(0.6 mg/kg)阿替普酶静脉溶栓。观察2组患者1 d、7 d、14 d NIHSS评分变化、90 d良好预后率(mRS≤2)及症状性出血发生率。结果溶栓组NIHSS评分下降明显,与未溶栓组比较,差异有统计学意义(P<0.05);溶栓组90 d良好预后患者多于未溶栓组,差异有统计学意义(P<0.05);症状性出血发生率比较,2组差异无统计学意义(P>0.05)。结论多模式MRI指导下,严格筛选超时间窗进展性脑梗死患者低剂量阿替普酶静脉溶栓,可获得良好临床效果,改善短期预后,症状性出血发生率无明显增加。

Clinical study on intravenous thrombolysis in progressive cerebral infarction of broadened therapeutic window under the guidance of multimode MRI

Objective To determine the efficacy and safety of intravenous thrombolysis with low-dose alteplase in progressive cerebral infarction of broadened therapeutic window.Methods Guided by multimode MRI,70 cases with progressive cerebral infarction in broadened therapeutic window(6 hours-12hours)as the research objects from Department 1 dated from January,2016 to November 2018 are selected.The 70 cases are divided into two groups,thrombolytic group(35 cases)and non-thrombolytic group(35 cases)according to the thrombosis or not.The non-thrombolytic group was given conventional treatment while the thrombolytic group was given intravenous thrombolysis enzyme with a low dose(0.6 mg/kg)on the basis of conventional treatment.The changes of 1d,7d,14dNIHSS score,good prognosis rate(mRS≤2)and incidence of symptomatic bleeding were observed in the two groups.Results The NIHSS score of the thrombolytic group decreased significantly,and the difference was statistically significant compared with the non-thrombolytic group(P<0.05).Patients in the thrombolytic group had better prognosis in 90d than those in the non-thrombolytic group,with statistically significant difference(P<0.05).The incidence of symptomatic bleeding was not significantly different between the two groups(P>.05).Conclusion Under the guidance of multi-mode MRI,patients suffering from progressive cerebral infarction of broadened therapeutic window and treated in intravenous thrombolysis with low-dose alteplase are strictly selected.The good clinical effects are achived,the short-term prognosis are improved,and the incidence of symptomatic bleeding does not increase significantly.