多模式MRI在急性脑梗死rt-PA静脉溶栓治疗中的评估作用.pdfVIP

天津医药2008年4月第36卷第4期 243 论著 多模式MRI在急性脑梗死rt—PA静脉溶栓治疗中的评估作用 薛 蓉 赵 伟 孙志华 吴 伟 张艳秋 程 焱 摘要 目的：评价多模式磁共振成像(MRI)在急性脑梗死重组组织型纤溶酶原激活剂(rt—PA)静脉溶栓中的作 用。方法：选择我院神经内科卒中单元筛选的35例符合溶栓标准CT阴性的脑梗死患者进行多模式MRI检查，进一 步评估其溶栓风险和获益。结果：9例患者不符合多模式MRI筛选标准，不适合进行溶栓治疗。另4例患者拒绝溶栓， 7例患者在溶栓前肌力好转未予溶栓，15例患者接受了rt—PA静脉溶栓。3个月随访改良Rankin评分(mRS)0～2分者 11例，3分者4例，无 5分患者，无颅内出血病例，无死亡病例。结论：对于发病3h之内的超早期脑梗死患者，溶栓前 多模式MRI评估有助于选择可能从rt-PA溶栓中获益的患者；对于发病3．O^_4．5 h的患者，能扩大rt—PA溶栓时间窗。 关键词 输注，静脉内 脑梗死 组织型纤溶酶原激活物 血栓溶解疗法 急性病 Application Value of Multi-modality Magnetic Resonance Imaging on Intravenous Thrombolysis with rt-PA in Acute Stroke XUE Rong，ZHAO Wei，SUN Zhihua，WU Wei，ZHANG Yanqiu，CHENG Yan Department ofNeurology，TianjinMedicalUniversityGeneralHospital，Tianjin300052，China Abstract Objective：To evaluate the value of multi-modality magnetic resonance imaging (MRI)on intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in acute cerebral infarction．Methods：T0tal 35 patients with acute cerebral infarction were enrolled．All patients were found normal on CT imaging and met the thmmbolysis criterion，and were scanned by multi—modality MRI to assess the risk and potential benefits．Results：Nine patients did not suit the multi-modality MRI thrombolysis criterion．Seven patients had improving neurological signs，4 patients rejected and 15 patients accepted rt—PA therapy．There were 11 cases with mRS 0-2 and 4 cases with mRS 3．There Was no death and hemorrhagic case．Conclusion：Multi-modality MRI is helpful to choose patients that may be benefit from thrombolysis therapy and exclude the risk of bleeding after thrombolysis and expensed rt-PA Use time window． Key words infusions，intraveno