多模式磁共振指导超时间窗急性缺血性卒中的静脉溶栓治疗研究

目的:评价多模式磁共振指导下超时间窗静脉应用重组组织型纤溶酶原激活剂rt PA治疗急性缺血性卒中的疗效及安全性。方法:将68例急性脑梗塞患者分为rt PA静脉溶栓组A组、强化抗栓治疗组B组,各组按药物干预时间再分为4.5小时亚组及4.5-6小时亚组。A组给予rt PA静脉溶栓治疗和常规治疗,B组给予首剂氯吡格雷300毫克+阿司匹林100毫克和常规治疗。治疗前行急诊头多模式磁共振检查,治疗24小时后复查头CT,分别于治疗前后不同时间点进行NIHSS评分和3个月MRS评分,记录不良事件的发生情况。结果:A组两个亚组治疗后各时间点NIHSS评分均明显低于B组,且A组4.5小时亚组治疗后NIHSS评分低于其4.5-6小时亚组,A组3个月预后良好患者比例显著高于B组,差异均有统计学意义(P0.05)。A组症状性颅内出血的发生率高于B组。结论:多模式头磁共振指导下超时间窗rt PA静脉溶栓治疗安全有效,远期疗效优于强化抗栓治疗,但颅内症状性出血风险略高于强化抗栓治疗。

Research on the Intravenous Thrombolytic Therapy for Acute Ischemic Stroke extended Time Window by Multimode MRI

Objective:To investigate the efficacy and safety of extending thrombolytic time window of recombinant tissue-type plasminogen activator (rtPA) in the therapy of acute ischemic stroke by multimode MRI.Methods:68 patients were divided into rtPA group (group A) with intravenous injection of rtPA (0.9 mg/kg) and normal drugs and routine group (group B) with normal drugs. Each group was divided into two subgroups depending on the onset time. Head CT/multimode MR and NIHSS/MRS were assessed before and after treatment. The incidence of adverse reactions were recorded.Results:The NIHSS scores at each time point after treatment were significantly lower in two subgroups of group A than those of groupB (P<0.05). The NIHSS score of less than 4.5h onset group was evidently lower than that of 4.5-6h group in group A(P<0.05). The percentage of better outcome patients was higher in group A than that in group B (P<0.05). Group A had higher risk of symptomatic intracranial hemorrhage than group B.Conclusion:Intravenous thrombolytic therapy for acute ischemic stroke extended time window by multimode MRI was safety and efficacy, which had better long-termresults than routine therapy, but with higher risk of symptomatic intracranial hemorrhage.