【摘要】：目的評(píng)價(jià)在溶栓時(shí)間窗內(nèi),對(duì)伴未破裂顱內(nèi)動(dòng)脈瘤(UIAs)的急性腦梗死(ACI)患者行靜脈溶栓治療的安全性。方法選取2010年1月—2015年12月在石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院神經(jīng)內(nèi)科卒中單元接受靜脈溶栓治療的ACI患者245例,均接受重組組織型纖溶酶原激活劑阿替普酶(rt-PA)靜脈溶栓治療。溶栓后36 h內(nèi)復(fù)查顱腦CT,36 h~7 d完成顱內(nèi)血管評(píng)估。根據(jù)血管評(píng)估結(jié)果,將納入患者分為無UIAs組(n=224)和UIAs組(n=21)。記錄并比較兩組患者溶栓前和溶栓7 d后的美國國立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分、溶栓90 d后的改良Rankin量表(mRS)分級(jí),以及溶栓后的出血情況。結(jié)果共檢出伴UIAs患者21例(8.6%),UIAs 25個(gè),直徑為2.0~8.0 mm,平均直徑為(4.1±1.7)mm。兩組患者性別、平均年齡、吸煙率、飲酒率、合并糖尿病發(fā)生率、合并高血壓發(fā)生率、合并高脂血癥發(fā)生率、合并心房顫動(dòng)發(fā)生率、發(fā)病至溶栓時(shí)間,溶栓前BMI、收縮壓、舒張壓,溶栓次日空腹血糖(FPG)、糖化血紅蛋白(Hb A_(1c))、總膽固醇(TC)、三酰甘油(TG)、血小板計(jì)數(shù)、尿酸比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05);UIAs組患者溶栓次日低密度脂蛋白(LDL)、同型半胱氨酸低于無UIAs組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。溶栓前和溶栓7 d后,兩組患者NIHSS評(píng)分比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05);溶栓7 d后兩組患者NIHSS評(píng)分均低于溶栓前,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。溶栓90 d后,兩組患者mRS為0~2級(jí)發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者溶栓后非癥狀性顱內(nèi)出血(N-s ICH)、癥狀性顱內(nèi)出血(s ICH)、蛛網(wǎng)膜下腔出血(SHA)發(fā)生率比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論對(duì)伴≤8.0 mm UIAs的ACI患者行靜脈溶栓治療可能不會(huì)增加患者的動(dòng)脈瘤破裂出血風(fēng)險(xiǎn),這為靜脈溶栓患者的選擇和判斷提供了依據(jù),但結(jié)果仍需大樣本研究的證實(shí)。
[Abstract]:Objective to evaluate the safety of intravenous thrombolysis in patients with acute cerebral infarction (ACI) with unruptured intracranial aneurysm (UIAs) in the thrombolytic time window. Methods from January 2010 to December 2015, 245 patients with ACI received intravenous thrombolytic therapy in the stroke unit of Department of Neurology, the first affiliated Hospital of Shihezi University, Medical College of Shihezi University. All patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). The evaluation of intracranial vessels was completed within 36 hours after thrombolytic therapy by reexamination of craniocerebral CT,36 hau 7 days after thrombolytic therapy. According to the results of vascular evaluation, the patients were divided into two groups: no UIAs group (n = 224) and UIAs group (n = 21). The (NIHSS) scores of stroke scale before and after thrombolytic therapy, the (mRS) grading of modified Rankin scale and bleeding after thrombolytic therapy were recorded and compared between the two groups. Results Twenty-one patients (8.6%), UIAs 25) with UIAs were found to have an average diameter of 8.0 mm, (4.1 鹵1.7 mm.). Sex, average age, smoking rate, alcohol consumption rate, incidence of diabetes, hypertension, hyperlipidemia, atrial fibrillation, time from onset to thrombolysis, systolic blood pressure of BMI, before thrombolytic therapy were observed in both groups. Diastolic blood pressure, fasting blood glucose (FPG), glycosylated hemoglobin (Hb A1c), total cholesterol (TC), triacylglycerol (TG), platelet count, uric acid) had no significant difference (P0.05). The low density lipoprotein (LDL) (LDL), homocysteine level in UIAs group was significantly lower than that in no UIAs group on the day after thrombolysis (P0.05). Before and 7 days after thrombolysis, there was no significant difference in NIHSS scores between the two groups (P0.05); after 7 days of thrombolysis, the NIHSS scores of the two groups were lower than those before thrombolysis (P0.05). After 90 days of thrombolytic therapy, there was no significant difference in the incidence of mRS between the two groups (P 0.05). There was no significant difference in the incidence of (SHA) between the two groups after thrombolytic non-symptomatic intracranial hemorrhage (N-s ICH), symptomatic intracranial hemorrhage, (s ICH), subarachnoid hemorrhage) (P0.05). Conclusion intravenous thrombolytic therapy for patients with ACI 鈮，

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