CAJ | 학술논문

目的研究CT灌注指导下r-tPA动脉溶栓治疗6～9h时间窗内急性脑梗死的疗效与安全性.方法前瞻对照研究2008年1月至2010年12月厦门大学附属第一医院神经内科收治的脑梗死患者,将63例发病6～9h内CT灌注成像提示存在缺血半暗带的急性脑梗死患者随机(随机数字法)分为A、B两组,A组给予r-tPA动脉接触溶栓,B组给予常规抗血小板等治疗.各组患者在治疗前、治疗后24 h和7d行NIHSS评分,90 d行mRS及BI评分以评定临床预后；A组患者术前、术后行脑血管DSA检查,判定闭塞血管再通情况；两组患者24 h内均复查颅脑CT,观察是否合并脑出血.结果 A组30例,B组33例；治疗前后比较,NIHSS评分差异24 h时A组差异有统计学意义(P＜0.01),B组差异无统计学意义(P＞0.05),7d时两组均有统计学意义(P＜0.01),组间比较显示A组较B组在治疗后24 h、7d时NIHSS评分下降更显著(P＜0.01)；治疗后90 d良好预后者A组明显多于B组(P＜0.05)；A组溶栓治疗后成功再通20例(66.67％),24h内有2例并发脑出血,与B组比较差异无统计学意义(P＞0.05).结论 CT灌注指导下r-tPA动脉溶栓是治疗6～9h时间窗内急性脑梗死的一种安全有效方法.
목적 연구CT관주지도하r-tPA동맥용전치료6～9h시간창내급성뇌경사적료효여안전성.방법 전첨대조연구2008년1월지2010년12월하문대학부속제일의원신경내과수치적뇌경사환자,장63례발병6～9h내CT관주성상제시존재결혈반암대적급성뇌경사환자수궤(수궤수자법)분위A、B량조,A조급여r-tPA동맥접촉용전,B조급여상규항혈소판등치료.각조환자재치료전、치료후24 h화7d행NIHSS평분,90 d행mRS급BI평분이평정림상예후；A조환자술전、술후행뇌혈관DSA검사,판정폐새혈관재통정황；량조환자24 h내균복사로뇌CT,관찰시부합병뇌출혈.결과 A조30례,B조33례；치료전후비교,NIHSS평분차이24 h시A조차이유통계학의의(P＜0.01),B조차이무통계학의의(P＞0.05),7d시량조균유통계학의의(P＜0.01),조간비교현시A조교B조재치료후24 h、7d시NIHSS평분하강경현저(P＜0.01)；치료후90 d량호예후자A조명현다우B조(P＜0.05)；A조용전치료후성공재통20례(66.67％),24h내유2례병발뇌출혈,여B조비교차이무통계학의의(P＞0.05).결론 CT관주지도하r-tPA동맥용전시치료6～9h시간창내급성뇌경사적일충안전유효방법.
Objective To determine the safety and efficacy of intra-arterial recombinant tissue plasminogen activator (r-tPA) for the treatment of acute cerebral infarction (ACI) in patients under the guidance of computed tomography perfusion-based selection within a 6-9 hour window.Methods Sixtythree ACI patients selected by using computed tomography perfusion imaging (CTPI) identifying thresholds for salvageable penumbra were randomly (random number) assigned to the group treated with intra-arterial thrombolysis with r-tPA (group A,n =30) or to the group managed with conventional anti-platelet aggregation agent (group B,n =33) within a 6-9 hour window.The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale score (mRS) and Barthel Index (BI) were used for evaluating therapeutic efficacy.Global brain digital subtraction angiography (DSA) was done pre-and posttreatment to observe the recanalization of occluded vessels in the group A.All patients were monitored with CT scan within 24 hours to determine the cerebral hemorrhage,an unexpected complication of thrombolysis.Results Compared with pre-treatment,there were significant differences in NIHSS 24 hours after treatment in the group A and 7 days after treatment in both groups (P ＜ 0.01).However,there were no significant differences in NIHSS 24 hours after treatment in the group B.More improvements in NIHSS at 24 hours and 7 days after treatment were observed in the group A than those in group B (P ＜ 0.01),and more patients with favorable outcomes identified by mRS and BI in the group A than those in the group B (P =0.017 and P =0.016,respectively).In addition,twenty patients were showed successful recanalization in the group A and there were 2 cases of cerebral hemorrhage occurred in the group A,and there was no significant difference in the incidence of cerebral hemorrhage within 24 hours between the two groups (P ＞ 0.05).Conclusions Intra-arterial thrombolysis with r-tPA for treatment of acute cerebral infarction was safe and effective within a 6-9 hour window under the guidance of CTPI.