超声助溶治疗急性大脑中动脉闭塞性脑梗死的临床研究

目的 探讨经颅多普勒超声联合rt-PA静脉溶栓治疗急性大脑中动脉闭塞性脑梗死的有效性及安全性,同时探索超声助溶的合适时间。方法 急性大脑中动脉闭塞性脑梗死患者73例,所有患者均行rt-PA静脉溶栓治疗,并按照超声助溶的时间随机分为3组,2 h超声助溶组24例、1.5 h超声助溶组25例和对照组24例。采用脑缺血溶栓血流分级判断血管再通情况,用美国国立卫生研究院卒中量表评分评估患者神经功能缺损程度,以溶栓后有无症状性颅内出血来评定其安全性,溶栓后3个月用改良Rankin量表及Barthel指数评分评定远期预后。结果 2 h助溶组与1.5 h助溶组治疗后2 h血管再通率以及治疗后3个月BI值显著高于对照组(P<0.05),而2助溶组之间血管再通率无明显差异(P>0.05); 2 h助溶组与1.5 h助溶组治疗24 h后NIHSS评分、治疗后3个月mRS评分显著低于对照组(P<0.05),而2助溶组之间无明显差异(P>0.05); 3组患者治疗后24 h均未出现症状性颅内出血。结论 超声助溶治疗急性大脑中动脉闭塞性脑梗死安全、有效、远期预后良好,而针对于助溶时间选择上建议将时间缩短至1.5 h。

Clinical research on sonothrombolysis in acute infarction of middle cerebral artery occlusion

ObjectiveTo evaluate the efficacy and safety of transcranial Doppler ultrasonography(TCD)combined with recombinant tissue-type plasminogen activator(rt-PA)intravenous thrombolysis in acute infarction of middle cerebral artery occlusion therapy,and explore the appropriate time of sonothrombolysis.Methods The acute infarction of middle cerebral artery occlusion patients(75 cases),who received rt-PA intravenous thrombolysis, were randomly divided into 3 groups:2 h sonothrombolysis group(24 cases)according to sonothrombolysis time,1.5 h sonothrombolysis group(25 cases)and control group(24 cases without sonothrombolysis).Artery recanalization was analyzed by TIBI rating,the degree of neurological functional impairment was evaluated by National Institutes of Health Stroke Scale(NIHSS)score.After thrombolysis,the safety was evaluated by symptomatic intracranial hemorrhage,and after thrombolysis 3 months,the long term prognosis was evaluated by mRS and Barthel index(BI)score.Results Compared to control group,2 h sonothrombolysis group and 1.5 h sonothrombolysis group showed significantly increased artery recanalization rate after 2 h therapy and BI score after 3 month therapy(P<0.05),also showed significantly decreased NIHSS score after 24 h therapy and mRS score after 3 month therapy(P<0.05),however,there were no difference between 2 h sonothrombolysis group and 1.5 h sonothrombolysis group.Besides,symptomatic intracranial hemorrhage didn't happen in 3 groups after 24 h therapy.Conclusion Sonothrombolysis is safe and effective for acute infarction of middle cerebral artery occlusion,and has a good long term prognosis.Moreover,it is suggested that the appropriate time of sonothrombolysis should be shortened to 1.5 h.