急性脑梗死溶栓治疗前后血流动力学的动态变化

目的观察急性脑梗死患者溶栓治疗前后脑血流动力学的动态变化。方法55例发病时间<6h的急性脑梗死患者接受静脉注射尿激酶75～150万单位。于治疗前后进行中国中风量表(CSS)评分,应用经颅三维多普勒(TCD)超声仪观察溶栓治疗前后脑血流动力学的变化。依据溶栓后1h患者神经功能的改善情况进行疗效评估。结果经溶栓治疗后显效者40例(72.7%),疗效不明显者15例(27.3%)。溶栓治疗前,显效组TCD表现异常者37例(92.5%),非显效组15例(100%),均表现为梗死侧脑血管血流速度下降或无信号,梗死灶对侧和椎-基底动脉血流信号明显增强,血流速度明显增快或正常,部分患者可闻及血管杂音并可见湍流表现。治疗后1h,显效组梗死侧血流速度增快,血管数量增加,与治疗前比较差异有显著性意义(P<0.05或P<0.01),梗死灶对侧和椎-基底动脉血流速度下降;非显效组则无明显变化。显效组有7例患者于溶栓后24h内出现反复。结论TCD可以客观地观察和评价急性脑梗死患者溶栓治疗前后脑血流动力学的动态变化,并可作为疗效判断和血管再闭塞的指标。

The hemodynamic changes after thrombolysis in acute cerebral infarction

Objective To study the cerebral hemodynamic changes after thrombolytic treatment in patients with acute cerebral infarction.Methods Fifty-five patients with acute onset of cerebral infarction within6hours were received intravenous injection of75to150myria-unit urokinase.All cases were scored with Chinese Stroke Scales(CSS)and the cerebral hemodynamic changes were assessed by measuring blood flow velocity in unilateral and contralateral arteries with three dimensional transcranial Doppler(TCD)before and after thrombolytic treatment.The therapeutic effects were evaluated by the improving patterns of neuro-function after treatment in1hour.Re sults The therapeutic effect were significant in40patients(40/55,72.7%)and not significant in15patients(15/55,27.3%)after thrombolysis.The abnormal TCD findings were found in37cases(37/40,92.5%)in significantly effective group and15cases(15/15,100%)in not signifi-cantly effective group.Reducing rate or signal disappeared in cerebrovascular blood flow of infarction side,significant increasing or normal blood flow rate and signal enhanced in opposite of infarction and vertebro-basal artery were found in all of the patients before treatment with thrombolysis.Vascular murmur and turbu-lent flow were found in some patients.One hour after treatment,the blood flow rate and vascular amount in-creased in infarction side compared to that before treatment with significant difference(P<0.05or P<0.01,respectively),and there were reducing rate of blood flow in vertebro-basal artery and brain opposite to infarc-tion side in significantly effective group.There were no dis tinct change in not significantly effective group.Seven patients with recurrent cerebral infarction were found in significantly effective group after thrombolysis within24hours.Con clu sion The pre-and post-therapeutic cerebro-hemodynamic changes during throm-bolysis in acute cerebral infarction can be objectively evaluated with TCD and also be adopted as the para-menters for evaluating the therapeutic effect or predicting the vascular reocclusion.[