液体衰减反转恢复序列在觉醒型缺血性脑卒中静脉溶栓中的价值

发布时间：2018-03-02 16:41

本文选题：缺血性脑卒中　切入点：磁共振　出处：《中国实用医药》2016年33期 　论文类型：期刊论文

【摘要】：目的探讨磁共振液体衰减反转恢复(FLAIR)序列指导下的觉醒型缺血性脑卒中(WUIS)患者静脉溶栓治疗的安全性及预后。方法 46例WUIS患者,经头颅CT检查排除颅内出血后,行急诊头颅磁共振检查,筛选出符合超急性期缺血性脑卒中,即弥散加权成像(DWI)出现高信号缺血病灶,而FLAIR序列无相应部位高信号的患者20例,列为WUIS组。同时选取发病时间4.5 h,无静脉溶栓禁忌证的急性脑梗死患者60例,列为标准治疗组。分别给予两组患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗。在溶栓后24 h对所有患者进行头颅CT复查,明确有无出血转化;在静脉溶栓后3个月对所有患者用改良Rankin量表(mRS)进行临床神经功能评估。结果两组患者基线资料比较差异无统计学意义(P0.05)。两组溶栓后24 h、7 d美国国立卫生研究院卒中量表(NIHSS)评分比较差异无统计学意义(P0.05)。WUIS组1例(5.0%)患者在溶栓后24 h复查头颅CT时发现有出血转化征象[1例出血性梗死(HI)-1,无HI-2及脑实质出血(PH)-1、PH-2]。标准治疗组有4例(6.7%)出现出血转化(2例HI-1,1例HI-2,无PH-1,1例PH-2),其中1例(1.7%)出现了症状性出血转化。两组比较差异无统计学意义(P=0.9580.05)。静脉溶栓后3个月时,WUIS组有9例(45.0%)临床神经功能恢复良好(mRS 0~2分),而标准治疗组有20例(33.3%)神经功能恢复良好,两组比较差异无统计学意义(P=0.3650.05)。结论磁共振FLAIR序列指导下的WUIS静脉溶栓治疗是安全的,有效的。
[Abstract]:Objective to investigate the safety and prognosis of intravenous thrombolytic therapy in patients with awakened ischemic stroke guided by magnetic resonance fluid attenuated inversion recovery (FLAIRR) sequence. Methods 46 patients with WUIS were excluded from intracranial hemorrhage by cranial CT. Emergency cranial magnetic resonance imaging was performed to screen out 20 patients with hyperintense ischemic lesions in accordance with hyperacute ischemic stroke, I. E. diffusion weighted imaging (DWI), but without corresponding hyperintense FLAIR sequences. As WUIS group, 60 patients with acute cerebral infarction with no contraindication of intravenous thrombolytic therapy were selected for 4.5 hours. The patients in the two groups were treated with recombinant tissue plasminogen activator (rt-PA) intravenous thrombolytic therapy, and all patients were examined with CT at 24 hours after thrombolysis to determine whether there was hemorrhage or not. The clinical neurological function of all patients was evaluated with modified Rankin scale mRS3 months after intravenous thrombolysis. Results there was no significant difference in baseline data between the two groups (P 0.05). There was no significant difference in stroke scale / NIHSS score. There was no significant difference between the two groups (P0.05U. WUIS group (1 case)) after 24 hours of thrombolytic therapy, there were signs of haemorrhage transformation [1 case of hemorrhagic infarction, 1 case of hemorrhagic infarction, no HI-2 and cerebral parenchymal hemorrhage (PH-1PH-2)]. 4 cases in the standard treatment group were found to have signs of hemorrhage conversion in 24 hours after thrombolytic therapy. There were 4 cases in the standard treatment group. There were 2 cases with HI-1 and 1 case with HI-2and 1 case without PH-1N, among which 1 case had symptomatic hemorrhage transformation. There was no significant difference between the two groups. 3 months after intravenous thrombolysis, 9 cases in WUIS group had good recovery of clinical nerve function. In the standard treatment group, 20 cases (33. 3%) had good recovery of nerve function. There was no statistical difference between the two groups. Conclusion the intravenous thrombolytic therapy of WUIS guided by magnetic resonance FLAIR sequence is safe and effective.
【作者单位】：扬州市第一人民医院神经内科;
【分类号】：R743.3

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