CAJ | 학술논문

目的：探讨急性缺血性卒中接受重组组织型纤溶酶原激活剂（ Recombinant Tissue Plasminogen Activa-tor，rt-PA）静脉溶栓治疗后大脑中动脉再通患者的临床预后情况。方法回顾性分析2013年9月至2014年9月，于天津市环湖医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者资料552例。入选患者按照0．9 mg／kg剂量标准，给予rt-PA静脉溶栓治疗。所有患者于溶栓前及溶栓后24 h进行头部MRA检查，采用TICI血管再通分级标准判断大脑中动脉的再通情况。其中根据溶栓后24 h MRA检查结果分为血管再通组（188例），血管未通组（364例）。溶栓前及溶栓后24 h的神经功能缺损评分及疗效判定，采用美国国立卫生研究院卒中量表（ National Institute of Health Stroke Scale，NIHSS）。神经功能的预后评价，采用改良Rankin评分（ modified Rankin Scale，mRS）。对2组患者溶栓后颅内出血（ intracranial hemorrhage，ICH）、症状性颅内出血（ symptomatic intracranial hemorrhage，SICH）的发生率、死亡率、神经功能缺损恢复及预后情况进行统计对比分析。结果血管再通组患者的恢复良好率和预后良好率均高于血管未通组，差异有统计学意义（ P ＜0．05）。血管再通组患者未出现症状性颅内出血，有6例患者出现了非症状性颅内出血。血管再通组及血管未通组的颅内出血发生率、其他部位出血率和住院期间死亡率差异均无统计学意义（P＞0．05）。结论研究结果表明，急性缺血性卒中患者在接受静脉溶栓治疗后，大脑中动脉再通的患者较未通患者神经功能缺损症状改善明显。静脉溶栓后，血管再通的患者临床预后获益更大。
목적：탐토급성결혈성졸중접수중조조직형섬용매원격활제（ Recombinant Tissue Plasminogen Activa-tor，rt-PA）정맥용전치료후대뇌중동맥재통환자적림상예후정황。방법회고성분석2013년9월지2014년9월，우천진시배호의원신경내과접수정맥용전치료적급성결혈성졸중환자자료552례。입선환자안조0．9 mg／kg제량표준，급여rt-PA정맥용전치료。소유환자우용전전급용전후24 h진행두부MRA검사，채용TICI혈관재통분급표준판단대뇌중동맥적재통정황。기중근거용전후24 h MRA검사결과분위혈관재통조（188례），혈관미통조（364례）。용전전급용전후24 h적신경공능결손평분급료효판정，채용미국국립위생연구원졸중량표（ National Institute of Health Stroke Scale，NIHSS）。신경공능적예후평개，채용개량Rankin평분（ modified Rankin Scale，mRS）。대2조환자용전후로내출혈（ intracranial hemorrhage，ICH）、증상성로내출혈（ symptomatic intracranial hemorrhage，SICH）적발생솔、사망솔、신경공능결손회복급예후정황진행통계대비분석。결과혈관재통조환자적회복량호솔화예후량호솔균고우혈관미통조，차이유통계학의의（ P ＜0．05）。혈관재통조환자미출현증상성로내출혈，유6례환자출현료비증상성로내출혈。혈관재통조급혈관미통조적로내출혈발생솔、기타부위출혈솔화주원기간사망솔차이균무통계학의의（P＞0．05）。결론연구결과표명，급성결혈성졸중환자재접수정맥용전치료후，대뇌중동맥재통적환자교미통환자신경공능결손증상개선명현。정맥용전후，혈관재통적환자림상예후획익경대。
Objective To evaluate the clinical prognosis of patient with middle cerebral artery recanalization after intravenous thrombolysis by recombinant tissue plasminogen activator ( rt-PA) for acute ischemic stroke.Methods The data of 552 patients with acute ischemic stroke from September 2013 to September 2014,who were treated by rt-PA intravenous thrombolysis in Neurology Department of Tianjin Huanhu Hospital,were retrospectively analyzed.All the patients underwent head MRA examination before and 24h after intravenous thrombolysis,and the recanalization condition of middle cerebral artery was evaluated according to TICI revascularization classification criteria.According to the results of MRA examination 24h after thrombolysis,the patients were divided into revascularization group ( n =188) and recanalization failure group (364 cases) . The neurologic impairment scoring and therapeutic effect before and 24h after intravenous thrombolysis were assessed according to National Institute of Health Stroke Scale (NIHSS).The prognostic evaluation was performed according to modified Rankin Scale ( mRS ) .The incidences of intracranial hemorrhage ( ICH ) , symptomatic intracranial hemorrhage ( SICH ) after thrombolysis,the patient's mortality,the condition of neurologic impairment recovery and prognosis were analyzed and compared statistically between the two group.Results The good recovery rates and good prognosis rates at 7d and 90d after thrombolysis in recanalization group were significantly higher than those in recanalization failure group ( P <0.05).No symptomatic ICH cases were found in recanalization group,but there were 6 cases of asymptomatic ICH.There were no significant differences in the incidences of intracranial hemorrhage after thrombolysis between two groups (3.2% vs 6.6%, P >0.05),in the incidences of hemorrhage in the other position (15.9%vs 20.3%, P >0.05),and mortality duration of hospital stay (0 vs 1.6%) .Conclusion The neurologic impairment symptoms of patients with middle cerebral artery recanalization are obviously improved after intravenous thrombolysis by rt-PA for acute ischemic stroke.After intravenous thrombolysis the clinical prognosis in patients with revascularization is much better than that of patients without revascularization.