CAJ | 학술논문

目的：探讨溶栓治疗在存在缺血半暗带的急性脑梗塞于超时间窗(>4.5h)应用的价值。方法选择在发病12h内，且磁共振检查发现具有半暗带证据，即灌注成像-弥散成像不匹配，(PWI-DWI)/DWI%>20%的48例急性脑梗塞患者分为溶栓组和对照组，溶检组给予重组组织型纤溶酶原激活剂(rt-PA)0.6～0.9mg/kg静脉溶栓治疗及溶栓治疗，对照组只做常规治疗。两组患者在溶检前和溶栓后2w、3个月分别行美国国立卫生院卒中量表(NIHSS)评分和日常生活能力量表(ADL)评分。结果溶栓组在溶栓后2w、3个月NIHSS评分均较对照组降低(P<0.01)；ADL评分较对照组明显升高(P<0.01)。结论对存在半暗带的急性脑梗塞，适当延长溶检时间窗可减小最终的梗塞面积，改善患者预后，提高患者生活质量。
목적：탐토용전치료재존재결혈반암대적급성뇌경새우초시간창(>4.5h)응용적개치。방법선택재발병12h내，차자공진검사발현구유반암대증거，즉관주성상-미산성상불필배，(PWI-DWI)/DWI%>20%적48례급성뇌경새환자분위용전조화대조조，용검조급여중조조직형섬용매원격활제(rt-PA)0.6～0.9mg/kg정맥용전치료급용전치료，대조조지주상규치료。량조환자재용검전화용전후2w、3개월분별행미국국립위생원졸중량표(NIHSS)평분화일상생활능역량표(ADL)평분。결과용전조재용전후2w、3개월NIHSS평분균교대조조강저(P<0.01)；ADL평분교대조조명현승고(P<0.01)。결론대존재반암대적급성뇌경새，괄당연장용검시간창가감소최종적경새면적，개선환자예후，제고환자생활질량。
Objective To explore the value of thrombolytic therapy with broadened therapeutic window(>4.5h) in patients with acute cerebral infarcts, with magnetic resonance perfusion-weighted imaging(PWI)-diffusion-weighted imaging(DWI) mismatch. Methods 48 patients with acute cerebral infarcts who were imaged by magnetic resonanceand (PWI-DWI)/DWI>20% within 12 hours after symptom onset were divided into thromobolytic group and control group.The patients in thro-mobolytic group were treated with intravenous rt-PA(0.6~0.9mg/kg) and common therapy, the con-trols were received common therapy. The two groups were scored with national institutes of health stroke scale (NIHSS)/activities of daily living (ADL) score respectively at pre-thrombolysis, 2W and 3M after thrombolysis. Results The NIHSS score of the thromobolytic group at 2W and 3M after thrombolysis was lower than that of the control group(P<0.01), the ADL score of the thromobolytic group at 2W and 3M afrer thrombolysis was higher than that of the control group significantly(P<0.01).Conclusion Thrombolytic therapy beyond the time window (>4.5h) in patients with acute cerebral infarcts,with magnetic resonance perfusion-weighted imaging (PWI)-diffusion-weighted imag-ing(DWI) mismatch, is beneficial and feasible.