论文部分内容阅读
目的:评价多模式磁共振指导下超时间窗静脉应用重组组织型纤溶酶原激活剂rt PA治疗急性缺血性卒中的疗效及安全性。方法:将68例急性脑梗塞患者分为rt PA静脉溶栓组A组、强化抗栓治疗组B组,各组按药物干预时间再分为<4.5小时亚组及4.5-6小时亚组。A组给予rt PA静脉溶栓治疗和常规治疗,B组给予首剂氯吡格雷300毫克+阿司匹林100毫克和常规治疗。治疗前行急诊头多模式磁共振检查,治疗24小时后复查头CT,分别于治疗前后不同时间点进行NIHSS评分和3个月MRS评分,记录不良事件的发生情况。结果:A组两个亚组治疗后各时间点NIHSS评分均明显低于B组,且A组<4.5小时亚组治疗后NIHSS评分低于其4.5-6小时亚组,A组3个月预后良好患者比例显著高于B组,差异均有统计学意义(P<0.05)。A组症状性颅内出血的发生率高于B组。结论:多模式头磁共振指导下超时间窗rt PA静脉溶栓治疗安全有效,远期疗效优于强化抗栓治疗,但颅内症状性出血风险略高于强化抗栓治疗。
OBJECTIVE: To evaluate the efficacy and safety of multi-modal MRI in the treatment of acute ischemic stroke with rtPA over orthotropic vein. Methods: A total of 68 patients with acute cerebral infarction were divided into group rtPA with intravenous thrombolysis and group B with intensive antithrombotic therapy. Each group was subdivided into <4.5 hours subgroup and 4.5-6 hours subgroup according to the time of drug intervention. Group A was given rt PA intravenous thrombolysis and conventional treatment, Group B was given the first dose of clopidogrel 300 mg + aspirin 100 mg and conventional treatment. Before treatment, emergency head multimodal MRI was performed. After 24 hours of treatment, the head CT was reviewed. NIHSS and MRS scores were recorded at different time points before and after treatment, and the incidence of adverse events was recorded. Results: The NIHSS scores of two subgroups of A group were significantly lower than those of B group at all time points after treatment, and the NIHSS score of subgroup 4.5 hours after subgroup A was lower than that of subgroup 4.5-6 hours The proportion of good patients was significantly higher than that of group B, the differences were statistically significant (P <0.05). The incidence of symptomatic intracranial hemorrhage in group A was higher than that in group B. CONCLUSION: The multi-modal head magnetic resonance (MRI) guided rt PA thrombolysis is safe and effective, and the long-term curative effect is better than that of intensive antithrombotic therapy. However, the risk of intracranial symptomatic hemorrhage is slightly higher than that of intensive antithrombotic therapy.