中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2013年
11期
1096-1100
,共5页
孙士富%何国军%左其龙%柯开富
孫士富%何國軍%左其龍%柯開富
손사부%하국군%좌기룡%가개부
前循环%缺血性脑卒中%动脉溶栓%超时间窗%CT灌注
前循環%缺血性腦卒中%動脈溶栓%超時間窗%CT灌註
전순배%결혈성뇌졸중%동맥용전%초시간창%CT관주
Anterior circulation%Ischemic stroke%Intra-arterial thrombolysis%Beyond the time window%Computed tomography perfusion
目的 观察CT灌注指导下发病超过6h的前循环缺血性脑卒中患者行动脉溶栓治疗的安全性和有效性. 方法 回顾性收集自2003年7月至2012年12月在盐城市第一人民医院神经内科及南通大学附属医院神经内科住院的发病时间＞6h与≤6 h的前循环缺血性脑卒中动脉溶栓患者(分别为36例和30例)的临床资料,前组患者均在CT灌注指导下评估缺血半暗带、梗死核心区及其不匹配区,分析比较2组患者的临床特征、临床转归及并发症情况. 结果 发病时间≤6h组与发病时间＞6h患者经CT灌注筛选后早期神经功能改善率(13.3％vs 22.2％)、远期神经功能改善率(86.7％vs 77.7％)、血管再通率(80.0％vs 88.9％)、3个月后死亡率(6.7％ vs 16.7％)比较差异均无统计学意义(P=0.665,P=0.665,P=0.639,P=0.607). 结论 对发病时间＞6h的前循环缺血性脑卒中患者而言,经CT灌注严格筛选并进行动脉溶栓治疗3个月后神经功能改善明显,虽症状性颅内出血发生率较发病时间≤6h组有所增加,但死亡率并未明显增加,表明其安全有效.
目的 觀察CT灌註指導下髮病超過6h的前循環缺血性腦卒中患者行動脈溶栓治療的安全性和有效性. 方法 迴顧性收集自2003年7月至2012年12月在鹽城市第一人民醫院神經內科及南通大學附屬醫院神經內科住院的髮病時間＞6h與≤6 h的前循環缺血性腦卒中動脈溶栓患者(分彆為36例和30例)的臨床資料,前組患者均在CT灌註指導下評估缺血半暗帶、梗死覈心區及其不匹配區,分析比較2組患者的臨床特徵、臨床轉歸及併髮癥情況. 結果 髮病時間≤6h組與髮病時間＞6h患者經CT灌註篩選後早期神經功能改善率(13.3％vs 22.2％)、遠期神經功能改善率(86.7％vs 77.7％)、血管再通率(80.0％vs 88.9％)、3箇月後死亡率(6.7％ vs 16.7％)比較差異均無統計學意義(P=0.665,P=0.665,P=0.639,P=0.607). 結論 對髮病時間＞6h的前循環缺血性腦卒中患者而言,經CT灌註嚴格篩選併進行動脈溶栓治療3箇月後神經功能改善明顯,雖癥狀性顱內齣血髮生率較髮病時間≤6h組有所增加,但死亡率併未明顯增加,錶明其安全有效.
목적 관찰CT관주지도하발병초과6h적전순배결혈성뇌졸중환자행동맥용전치료적안전성화유효성. 방법 회고성수집자2003년7월지2012년12월재염성시제일인민의원신경내과급남통대학부속의원신경내과주원적발병시간＞6h여≤6 h적전순배결혈성뇌졸중동맥용전환자(분별위36례화30례)적림상자료,전조환자균재CT관주지도하평고결혈반암대、경사핵심구급기불필배구,분석비교2조환자적림상특정、림상전귀급병발증정황. 결과 발병시간≤6h조여발병시간＞6h환자경CT관주사선후조기신경공능개선솔(13.3％vs 22.2％)、원기신경공능개선솔(86.7％vs 77.7％)、혈관재통솔(80.0％vs 88.9％)、3개월후사망솔(6.7％ vs 16.7％)비교차이균무통계학의의(P=0.665,P=0.665,P=0.639,P=0.607). 결론 대발병시간＞6h적전순배결혈성뇌졸중환자이언,경CT관주엄격사선병진행동맥용전치료3개월후신경공능개선명현,수증상성로내출혈발생솔교발병시간≤6h조유소증가,단사망솔병미명현증가,표명기안전유효.
Objective To observe the safety and efficacy ofintra-arterial thrombolysis guided by CT perfusion in patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h.Methods The clinical data of patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h (n=36) and shorter than or equal to 6 h (n=30),performed intra-arterial thrombolysis in our hospitals from July 2003 to December 2012,were retrospectively evaluated.Patients of the former group were evaluated the ischemic penumbra and core region of infarction and the mismatch between the two regions based on CT perfusion.The clinical features,clinical outcomes and complications were compared between the two groups.Results As compared with those in patients of symptoms shorter than or equal to 6 h,the early neurological improvement rate (13.3％ vs.22.2％) and long-term neurological improvement rate (86.7％ vs.77.7％),recanalization rate (80.0％ vs.88.9％) and 3-month mortality (6.7％ vs.16.7％) of patients of symptoms longer than were not significantly different (P=0.665,P=0.665,P=0.639 and P=0.607).Conclusions To patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h,the neurological function at 3-month significantly improves after intra-arterial thrombolysis guided by CT perfusion.Although the incidence of symptomatic intracranial hemorrhage increases,the mortality rate does not significantly increase.
