本文選題：缺血性腦卒中　切入點：磁共振　出處：《中國實用醫(yī)藥》2016年33期 　論文類型：期刊論文

【摘要】：目的探討磁共振液體衰減反轉(zhuǎn)恢復(fù)(FLAIR)序列指導(dǎo)下的覺醒型缺血性腦卒中(WUIS)患者靜脈溶栓治療的安全性及預(yù)后。方法 46例WUIS患者,經(jīng)頭顱CT檢查排除顱內(nèi)出血后,行急診頭顱磁共振檢查,篩選出符合超急性期缺血性腦卒中,即彌散加權(quán)成像(DWI)出現(xiàn)高信號缺血病灶,而FLAIR序列無相應(yīng)部位高信號的患者20例,列為WUIS組。同時選取發(fā)病時間4.5 h,無靜脈溶栓禁忌證的急性腦梗死患者60例,列為標(biāo)準(zhǔn)治療組。分別給予兩組患者重組組織型纖溶酶原激活劑(rt-PA)靜脈溶栓治療。在溶栓后24 h對所有患者進行頭顱CT復(fù)查,明確有無出血轉(zhuǎn)化;在靜脈溶栓后3個月對所有患者用改良Rankin量表(mRS)進行臨床神經(jīng)功能評估。結(jié)果兩組患者基線資料比較差異無統(tǒng)計學(xué)意義(P0.05)。兩組溶栓后24 h、7 d美國國立衛(wèi)生研究院卒中量表(NIHSS)評分比較差異無統(tǒng)計學(xué)意義(P0.05)。WUIS組1例(5.0%)患者在溶栓后24 h復(fù)查頭顱CT時發(fā)現(xiàn)有出血轉(zhuǎn)化征象[1例出血性梗死(HI)-1,無HI-2及腦實質(zhì)出血(PH)-1、PH-2]。標(biāo)準(zhǔn)治療組有4例(6.7%)出現(xiàn)出血轉(zhuǎn)化(2例HI-1,1例HI-2,無PH-1,1例PH-2),其中1例(1.7%)出現(xiàn)了癥狀性出血轉(zhuǎn)化。兩組比較差異無統(tǒng)計學(xué)意義(P=0.9580.05)。靜脈溶栓后3個月時,WUIS組有9例(45.0%)臨床神經(jīng)功能恢復(fù)良好(mRS 0~2分),而標(biāo)準(zhǔn)治療組有20例(33.3%)神經(jīng)功能恢復(fù)良好,兩組比較差異無統(tǒng)計學(xué)意義(P=0.3650.05)。結(jié)論磁共振FLAIR序列指導(dǎo)下的WUIS靜脈溶栓治療是安全的,有效的。
[Abstract]:Objective to investigate the safety and prognosis of intravenous thrombolytic therapy in patients with awakened ischemic stroke guided by magnetic resonance fluid attenuated inversion recovery (FLAIRR) sequence. Methods 46 patients with WUIS were excluded from intracranial hemorrhage by cranial CT. Emergency cranial magnetic resonance imaging was performed to screen out 20 patients with hyperintense ischemic lesions in accordance with hyperacute ischemic stroke, I. E. diffusion weighted imaging (DWI), but without corresponding hyperintense FLAIR sequences. As WUIS group, 60 patients with acute cerebral infarction with no contraindication of intravenous thrombolytic therapy were selected for 4.5 hours. The patients in the two groups were treated with recombinant tissue plasminogen activator (rt-PA) intravenous thrombolytic therapy, and all patients were examined with CT at 24 hours after thrombolysis to determine whether there was hemorrhage or not. The clinical neurological function of all patients was evaluated with modified Rankin scale mRS3 months after intravenous thrombolysis. Results there was no significant difference in baseline data between the two groups (P 0.05). There was no significant difference in stroke scale / NIHSS score. There was no significant difference between the two groups (P0.05U. WUIS group (1 case)) after 24 hours of thrombolytic therapy, there were signs of haemorrhage transformation [1 case of hemorrhagic infarction, 1 case of hemorrhagic infarction, no HI-2 and cerebral parenchymal hemorrhage (PH-1PH-2)]. 4 cases in the standard treatment group were found to have signs of hemorrhage conversion in 24 hours after thrombolytic therapy. There were 4 cases in the standard treatment group. There were 2 cases with HI-1 and 1 case with HI-2and 1 case without PH-1N, among which 1 case had symptomatic hemorrhage transformation. There was no significant difference between the two groups. 3 months after intravenous thrombolysis, 9 cases in WUIS group had good recovery of clinical nerve function. In the standard treatment group, 20 cases (33. 3%) had good recovery of nerve function. There was no statistical difference between the two groups. Conclusion the intravenous thrombolytic therapy of WUIS guided by magnetic resonance FLAIR sequence is safe and effective.
【作者單位】： 揚州市第一人民醫(yī)院神經(jīng)內(nèi)科;
【分類號】：R743.3

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