CAJ | 학술논문

①目的探讨CT灌注成像（CTP）检查指导的重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗急性脑梗死的有效性和安全性。②方法选取发病9h内急性脑梗死患者29例，经患者或家属签署知情同意书后行CTP、CTA检查，对存在缺血半暗带且同意rt-PA静脉溶栓治疗的10例患者给予rt-PA 40mg静脉溶栓治疗。记录溶栓前、溶栓后2h、24h、10d、30d NIHSS评分及溶栓前、溶栓后30dBarthel指数评分，并进行比较，复查头颅CT，监测并发症。③结果纳入的10例患者治疗前 NIHSS 评分为（10．90±4．04），溶栓治疗后2、24h、10、30d NIHSS评分分别降至（6．90±3．60）、（6．70±4．11）、（4．10±3．60）、（3．20±3．19），不同时间点NIHSS评分差异有统计学意义。溶栓前Barthel指数评分为（38．50±22．24），溶栓后30dBarthel指数评分为（78．53±30．00），两者比较差异有统计学意义。发生牙龈出血1例，无颅内出血、再闭塞及死亡病例，CT复查8例患者显示病灶较CTP低灌注区明显缩小，2例无明显变化。④结论 CTP指导的 rt-PA静脉溶栓治疗安全有效，有助于筛选适合溶栓的患者，并能扩大治疗的时间窗。
①목적탐토CT관주성상（CTP）검사지도적중조조직형섬용매원격활제（rt-PA）정맥용전치료급성뇌경사적유효성화안전성。②방법선취발병9h내급성뇌경사환자29례，경환자혹가속첨서지정동의서후행CTP、CTA검사，대존재결혈반암대차동의rt-PA정맥용전치료적10례환자급여rt-PA 40mg정맥용전치료。기록용전전、용전후2h、24h、10d、30d NIHSS평분급용전전、용전후30dBarthel지수평분，병진행비교，복사두로CT，감측병발증。③결과납입적10례환자치료전 NIHSS 평분위（10．90±4．04），용전치료후2、24h、10、30d NIHSS평분분별강지（6．90±3．60）、（6．70±4．11）、（4．10±3．60）、（3．20±3．19），불동시간점NIHSS평분차이유통계학의의。용전전Barthel지수평분위（38．50±22．24），용전후30dBarthel지수평분위（78．53±30．00），량자비교차이유통계학의의。발생아간출혈1례，무로내출혈、재폐새급사망병례，CT복사8례환자현시병조교CTP저관주구명현축소，2례무명현변화。④결론 CTP지도적 rt-PA정맥용전치료안전유효，유조우사선괄합용전적환자，병능확대치료적시간창。
Objective To evaluate efficiency and safety of CT perfusion -based intravenous thrombolysis with recombinant tissue plasminogen activator ( rt-PA) in acute cerebral infarction .Methods 29 patients within 9 hours after symptom onset for a-cute cerebral infarction were enrolled in the study .After patients or relatives signed informed consent , they were scanned by CTP and CTA.10 patients with penumbra who agreed to accept rt -PA thrombolytic therapy were administrated with rt -PA 40mg.The NIH-SS was used to evaluate the recovery of neurological functions before , and 2 hours, 24 hours, 10 days and 30 days after thrombolytic therapy.A comparison of the Barthel Index (BI) was made 30 day after treatment.CT was also re-examined.The adverse effect and complication were monitored .Results 10 patients who met the CTP thrombolytic criterion and accepted rt -PA thrombolytic therapy were evaluated.The NIHSS score before, and 2 hours, 24 hours ,10 days and 30 days after rt-PA treatment was (10.90 ± 4.04), (6.90 ±3.60), (6.70 ±4.11), (4.10 ±3.60), (3.20 ±3.19), The improvement of NIHSS was significantly difference between before and after thrombolytic therapy .BI score before treatment was (38.50 ±22.24), and increased to (78.53 ±30.00) at 30d after treatment, and statistical differences were also found .Re-infarction and cerebral hemorrhagic were not seen and no death occurred .Among the 10 patients undergone CT reexamined , 8 patients'infarction areas were diminution obviously and 2 pa-tients'were remained .Conclusion CTP-based intravenous thrombolysis with rt -PA is safe and effective for patients with acute cerebral infarction , CTP is helpful to assess the patients who may obtain benefit from intravenous thrombolytic therapy and may ex -pand the time window .