r—tPA动脉溶栓治疗超时间窗急性脑梗死.docVIP

PAGE PAGE 1 r—tPA动脉溶栓治疗超时间窗急性脑梗死 　　【摘要】目的研究CT灌注指导下r-tPA动脉溶栓治疗6～9h时间窗内急性脑梗死的疗效与安全性。方法前瞻对照研究2008年1月至2010年12月厦门大学附属第一医院神经内科收治的脑梗死患者，将63例发病6～9h内CT灌注成像提示存在缺血半暗带的急性脑梗死患者随机（随机数字法）分为A、B两组，A组给予r-tPA动脉接触溶栓，B组给予常规抗血小板等治疗。各组患者在治疗前、治疗后24h和7d行NIHSS评分，90d行mRS及BI评分以评定临床预后；A组患者术前、术后行脑血管DSA检查，判定闭塞血管再通情况；两组患者24h内均复查颅脑CT，观察是否合并脑出血。结果A组30例，B组33例；治疗前后比较，NIHSS评分差异24h时A组差异有统计学意义（P0.05），7d时两组均有统计学意义（P0.05）。结论CT灌注指导下r-tPA动脉溶栓是治疗6～9h时间窗内急性脑梗死的一种安全有效方法。 　　【关键词】急性脑梗死；动脉溶栓；选择性重组组织型纤溶酶原激活物；CT灌注成像；缺血半暗带；时间窗；血管再通；神经功能 　　Intra-arterialthrombolysiswithr-tPAforthetreatmentofacutecerebralinfarction6to9hoursafteronsetBIMin，TONGSui-jun，ZHANGYi-dan，JIANGBin，CHENHan-shui，MAQi-lin.DepartmentofNeurology，XiamenFirstHospitalAffiliatedtoXiamenUniversity，Xiamen361003，China 　　Correspondingauthor：MAQi-lin，Email：qilinma@ 　　【Abstract】ObjectiveTodeterminethesafetyandefficacyofintra-arterialrecombinanttissueplasminogenactivator（r-tPA）forthetreatmentofacutecerebralinfarction（ACI）inpatientsundertheguidanceofcomputedtomographyperfusion-basedselectionwithina6-9hourwindow.MethodsSixty-threeACIpatientsselectedbyusingcomputedtomographyperfusionimaging（CTPI）identifyingthresholdsforsalvageablepenumbrawererandomly（randomnumber）assignedtothegrouptreatedwithintra-arterialthrombolysiswithr-tPA（groupA，n=30）ortothegroupmanagedwithconventionalanti-plateletaggregationagent（groupB，n=33）withina6-9hourwindow.TheNationalInstitutesofHealthStrokeScale（NIHSS）andthemodifiedRankinScalescore（mRS）andBarthelIndex（BI）wereusedforevaluatingtherapeuticefficacy.Globalbraindigitalsubtractionangiography（DSA）wasdonepre-andpost-treatmenttoobservetherecanalizationofoccludedvesselsinthegroupA.AllpatientsweremonitoredwithCTscanwithin24hourstodeterminethecerebralhemorrhage，anunexpectedcomplicationofthrombolysis.ResultsComparedwithpre-treatment，thereweresignificantdifferencesinNIHSS24hoursaftertreatmentinthegroupAand7daysaftertreatmentinbothgroups（P0.05）.ConclusionsIntra-arterialthrombolysiswithr-tPAfortreatmentofacutecerebralinfarctionwassafeandeffectivew