经颅多普勒超声脑缺血溶栓分级与阿替普酶静脉溶栓治疗急性前循环不同大动脉闭塞性脑梗死预后相关性研究

doi:10.3969/j.issn.1673-5765.2017.04.003

摘要/Abstract

摘要：

目的探讨分析经颅多普勒超声脑缺血溶栓分级与静脉溶栓治疗急性前循环不同大动脉闭塞性脑梗死患者血管再通评价与预后的相关性研究。方法选择急性前循环大动脉闭塞性脑梗死患者，对符合静脉溶栓者给予阿替普酶静脉溶栓治疗，分别于溶栓前及溶栓后24 h行床旁经颅多普勒超声（transcranial Doppler，TCD）检查并记录脑缺血溶栓分级（thrombolysis in brain ischemia，TIBI）。采用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分记录患者临床神经功能缺损，3个月随访时采用改良Rankin量表（modified Rankin Scale，mRS）评分评估患者预后，分析前循环不同大血管闭塞性脑梗死患者静脉溶栓前后血管再通情况及患者3个月预后。结果共入选46例患者，其中颈内动脉（internal c arotid a rtery，ICA）闭塞患者19例，大脑中动脉（middle cerebral artery，MCA）闭塞患者27例。溶栓前与溶栓后24 h TCD监测TIBI分级提示血管再通者， ICA闭塞组5.26%，MCA闭塞组55.56%。ICA闭塞组与MCA闭塞组比较，MCA闭塞组90 d随访生活自理及良好预后的比例均高于ICA闭塞组，死亡率低于ICA闭塞组，而两组间溶栓后的症状性颅内出血发生率差异无显著性。结论急性前循环大动脉闭塞性脑梗死经静脉溶栓治疗后可获得血管再通，尤其是MCA闭塞患者；溶栓前后TIBI血流分级变化可反映大动脉血管再通情况，且有助于判断患者临床预后。

文章导读： 本研究显示阿替普酶静脉溶栓治疗大血管闭塞所致急性缺血性卒中，大脑中动脉闭塞患者血管开通率高于颈内动脉闭塞者；应用床旁经颅多普勒超声可实时观察静脉溶栓治疗后的血管开通情况。

关键词: 经颅多普勒超声; 脑缺血溶栓分级; 急性缺血性卒中; 静脉溶栓; 预后

Abstract:

Objective To investigate and evaluate the intravenous thrombolytic therapeutic recanalization of acute ischemic stroke patients with different large vessel occlusion in the anterior circulation, and the association between thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades and the outcome of ischemic stroke patients. Methods Patients diagnosed as acute ischemic stroke with a proximal vessel occlusion in the anterior circulation were selected as subjects. Those who were able to receive intravenous thrombolysis were given alteplase intravenous thrombolysis therapy. Thrombolysis in brain ischemia (TIBI) flow grades of large vessels before and 24 h after thrombolysis were assessed by

transcranial Doppler (TCD). National Institutes of Health Stroke Scale (NIHSS) was used to record the neurologic impairment of patients. The modified Rankin Scale (mRS) was used at 3 months follow-up to analyze the recanalization before and after thrombolysis of proximal vessel occlusion in the Anterior Circulation and 3-months prognosis. Results A total of 46 patients were included. There were 19 cases of internal carotid artery (ICA) occlusion and 27 cases of middle cerebral artery (MCA) occlusion. The 24 h TCD monitored TIBI before and after thrombolysis showed that the rates of recanalization of ICA occlusion group and MCA occlusion group were 5.26% and 55.56%, respectively. For the functional independence outcome at 90 days, MCA occlusion group was significantly better than ICA occlusion group. For excellent recovery outcome at 90 days, MCA occlusion group was also significantly better than ICA occlusion group. For mortality, MCA group was significantly lower than ICA group. There were no significant differences between MCA group and ICA group in the symptomatic intracranial hemorrhage. Conclusion The intravenous thrombolytic therapeutic recanalization of the acute ischemic stroke patients with large vessel occlusion in the anterior circulation was effective, in particular to patients with MCA occlusion. The changes of TIBI grade system blood flow grades before and after thrombolysis could reflect the status of recanalization, which is helpful in judging the clinical prognosis of patients.

Key words: Transcranial Doppler; Thrombolysis in brain ischemia (TIBI); Acute ischemic stroke; Thrombolysis; Prognosis

车锋丽，陈胜云，杨中华，赵性泉，杜会山，魏建朝，孟繁花，张伟东. 经颅多普勒超声脑缺血溶栓分级与阿替普酶静脉溶栓治疗急性前循环不同大动脉闭塞性脑梗死预后相关性研究[J]. 中国卒中杂志, 2017, 12(04): 302-308.

CHE Feng-Li, CHEN Sheng-Yun,YANG Zhong-Hua, et al.. The Correlation Study on Thrombolysis in Brain Ischemia (TIBI) Transcranial Doppler Flow Grades and the Outcomes of Ischemic Stroke Patients with Different Proximal Vessel Occlusion in the Anterior Circulation Treated with Intravenous Tissue Plasminogen Activator[J]. Chinese Journal of Stroke, 2017, 12(04): 302-308.

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