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目的探讨CT灌注成像(CTP)指导下对不明发病时间急性脑梗死患者溶栓治疗的有效性和安全性。方法收集不明发病时间急性脑梗死患者61例,经CTP检查存在缺血半暗带,符合CTP筛选溶栓标准,行组织型纤溶酶原激活物抑制剂阿替普酶注射剂静脉溶栓8例(CTP组),CTP检查不存在缺血半暗带行常规药物保守治疗36例(未溶栓组),另选取同期发病时间<4.5h急性脑梗死患者17例(对照组)。使用美国国立卫生研究院卒中量表(NIHSS)评价3组治疗前、治疗后24h及14d疗效,治疗后临床治愈率、颅内出血发生率。结果3组治疗前NIHSS评分比较,差异无统计学意义(P>0.05)。与未溶栓组比较,CTP组和对照组治疗后24h及14dNIHSS评分明显降低,差异有统计学意义(P<0.01);而CTP组与对照组溶栓后24h、14dNIHSS评分比较,差异无统计学意义(P>0.05)。CTP组和对照组治疗后14d临床治愈率明显高于未溶栓组(62.5%,58.8%vs 11.1%,P=0.006,P=0.001);CTP组与对照组治疗后14d临床治愈率比较,差异无统计学意义(P=1.000)。结论 CTP对不明发病时间急性脑梗死患者静脉溶栓治疗有一定的指导意义。
Objective To investigate the effectiveness and safety of CT perfusion imaging (CTP) for thrombolytic therapy in patients with acute cerebral infarction (ACI) of unknown onset. Methods Sixty-one patients with acute cerebral infarction (ACI) of unknown onset time were collected. The ischemic penumbra was detected by CTP. According to the criteria of CTP thrombolysis, eight patients received intravenous thrombolysis with tissue plasminogen activator inhibitor alteplase (CTP group), CTP examination did not exist in the penumbra with conventional conservative treatment of 36 cases (without thrombolysis group), the other with the same period of onset <4.5h acute cerebral infarction in 17 patients (control group). The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the efficacy, the clinical cure rate and the incidence of intracranial hemorrhage in three groups before treatment, 24h and 14d after treatment. Results There was no significant difference in NIHSS score between the three groups before treatment (P> 0.05). Compared with no thrombolytic group, the scores of NIHSS at 24h and 14d in CTP group and control group decreased significantly (P <0.01), but there was no statistic difference between CTP group and control group at 24h and 14d after thrombolysis Significance (P> 0.05). The clinical cure rates of CTP group and control group on 14th day after treatment were significantly higher than those of non-thrombolytic group (62.5%, 58.8% vs 11.1%, P = 0.006, P = 0.001) The difference was not statistically significant (P = 1.000). Conclusion CTP has some guiding significance for the thrombolytic therapy in patients with acute cerebral infarction of unknown onset time.