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目的了解多模式MRI检查对急性缺血性脑卒中静脉溶栓治疗的指导作用,保证静脉溶栓治疗的有效性和安全性。方法选取2013年8月—2015年8月收治的102例急性缺血性脑卒中患者。根据多模式MRI检查结果指导静脉溶栓治疗。不符合静脉溶栓患者作为对照组;入选的静脉溶栓患者作为治疗组,在对照组相同治疗方法的基础上,给予重组组织型纤溶酶原激活剂阿替普酶。比较2组治疗前和治疗后6 h、24 h、7 d的NIHSS评分,治疗7 d后评价疗效,并观察治疗期间的不良反应。结果根据PWI/DWI的不匹配性,治疗组55例符合静脉溶栓,对照组47例不符合静脉溶栓。2组的年龄、性别、吸烟史、卒中史、合并症等一般资料的差异均无统计学意义(P均>0.05)。治疗组治疗后6 h、24 h、7 d的NIHSS评分为8.52±4.77、6.14±4.07、3.90±2.23,均显著小于对照组(t=1.775、2.875、2.024,P均<0.05)。治疗组的总有效率为83.64%(46/55),显著高于对照组(χ~2=6.264,P<0.05)。治疗期间,对照组的不良反应发生率为10.64%(5/47),治疗组的不良反应发生率为12.73%(7/55);2组不良反应发生率的差异无统计学意义(χ~2=0.107,P>0.05)。结论多模式MRI对急性缺血性脑卒中静脉溶栓治疗具有指导作用,可提高静脉溶栓的疗效,具有较高的临床应用价值。
Objective To understand the guiding role of multimodal MRI in the treatment of thrombolytic therapy of acute ischemic stroke and to ensure the effectiveness and safety of intravenous thrombolysis. Methods Totally 102 acute ischemic stroke patients were selected from August 2013 to August 2015. Guided intravenous thrombolysis based on multimodal MRI findings. Patients who did not fit intravenous thrombolysis served as control group. The patients who received intravenous thrombolysis as the treatment group were given recombinant tissue plasminogen activator alteplase on the basis of the same treatment in the control group. The NIHSS scores of two groups before treatment and 6 h, 24 h and 7 d after treatment were compared. The therapeutic effect was evaluated after 7 d of treatment, and the adverse reactions during the treatment were observed. Results According to PWI / DWI mismatch, 55 patients in the treatment group were eligible for intravenous thrombolysis and 47 patients in the control group did not meet intravenous thrombolysis. There were no significant differences in general data of age, gender, smoking history, stroke history and comorbidity between the two groups (all P> 0.05). The NIHSS scores of the treatment group at 6 h, 24 h and 7 d after treatment were 8.52 ± 4.77, 6.14 ± 4.07 and 3.90 ± 2.23, respectively, which were significantly lower than those of the control group (t = 1.775,2.875,2.024, P <0.05). The total effective rate of the treatment group was 83.64% (46/55), which was significantly higher than that of the control group (χ ~ 2 = 6.264, P <0.05). The incidence of adverse reactions in the control group was 10.64% (5/47) during the treatment period, and the incidence of adverse reactions in the treatment group was 12.73% (7/55). There was no significant difference in the incidence of adverse reactions between the two groups (χ ~ 2 = 0.107, P> 0.05). Conclusions Multimodal MRI can guide intravenous thrombolytic therapy in acute ischemic stroke, which can improve the curative effect of intravenous thrombolysis and has high clinical value.