CAJ | 학술논문

目的探讨酒后脑梗死患者的特点、溶栓决策及结局。 　　方法选取2012年9月～2013年6月期间首都医科大学附属北京天坛医院神经内科急诊溶栓绿色通道的酒后脑梗死患者11例，收集患者的临床表现、影像特征、溶栓情况及结局进行回顾性分析。 　　结果11例酒后脑梗死患者发病0.5～8h进入急诊溶栓绿色通道，皆为男性，中位数年龄59岁（四分位数间距53.5～60），到达医院时平均中位数发病时间为120 min（四分位数间距45～250）。就诊时主要症状：9例为偏身无力，1例为偏身不自主运动，1例为单肢麻木。小卒中患者8例（73%）。临床过程及转归：2例接受静脉溶栓后明显改善，1例接受动脉溶栓后明显改善，2例拒绝溶栓后自发缓解，3例因症状轻微而未溶栓且自发缓解，2例发病超过3h的患者因磁共振灌注成像正常而未溶栓，1例发病超过3h的患者因磁共振弥散加权成像和灌注成像均正常而未溶栓。最终5例在影像上有明确的新发梗死灶。根据急性卒中治疗低分子肝素试验病因分型法（Trial of Org 10172 in Acute Stroke Treatment，TOAST）的分型标准，接受溶栓的3例患者中，2例为大动脉粥样硬化性闭塞，1例为小动脉闭塞；拒绝和未接受溶栓的8例患者均为小动脉闭塞。 　　结论酒后脑梗死多数预后好，有可能从溶栓中获益。酒后脑梗死病因多为小动脉闭塞，少部分是大动脉粥样硬化性闭塞。
목적탐토주후뇌경사환자적특점、용전결책급결국。 　　방법선취2012년9월～2013년6월기간수도의과대학부속북경천단의원신경내과급진용전록색통도적주후뇌경사환자11례，수집환자적림상표현、영상특정、용전정황급결국진행회고성분석。 　　결과11례주후뇌경사환자발병0.5～8h진입급진용전록색통도，개위남성，중위수년령59세（사분위수간거53.5～60），도체의원시평균중위수발병시간위120 min（사분위수간거45～250）。취진시주요증상：9례위편신무력，1례위편신불자주운동，1례위단지마목。소졸중환자8례（73%）。림상과정급전귀：2례접수정맥용전후명현개선，1례접수동맥용전후명현개선，2례거절용전후자발완해，3례인증상경미이미용전차자발완해，2례발병초과3h적환자인자공진관주성상정상이미용전，1례발병초과3h적환자인자공진미산가권성상화관주성상균정상이미용전。최종5례재영상상유명학적신발경사조。근거급성졸중치료저분자간소시험병인분형법（Trial of Org 10172 in Acute Stroke Treatment，TOAST）적분형표준，접수용전적3례환자중，2례위대동맥죽양경화성폐새，1례위소동맥폐새；거절화미접수용전적8례환자균위소동맥폐새。 　　결론주후뇌경사다수예후호，유가능종용전중획익。주후뇌경사병인다위소동맥폐새，소부분시대동맥죽양경화성폐새。
Objective Alcohol drinking is a trigger factor of cerebral infarction. We summarize and discuss the characteristics, thrombolysis decisions and outcomes of alcohol-triggered cerebral infarction. Methods We retrospectively selected patients with alcohol-triggered cerebral infarction presented to the Code Stroke System of Beijing Tiantan Hospital from September 2012 to June 2013. Data of clinical presentations, imaging, thrombolysis and outcomes were collected. Results Eleven cases of patients with alcohol-triggered cerebral infarction within 0.5~8 hours after onset were presented to the Code Stroke System of Beijing Tiantan Hospital from September 2012 to June 2013. All the patients were male, with a median age of 59 years (interquartile range 53.5~60). Median interval from the onset to arrival at hospital were 120 minutes (interquartile range 45~250).The main symptoms at presentation:9 cases with partial body weakness, 1 case with involuntary movements, 1 case with single-limb numbness. Minor stroke accounted for 73% (8%). The clinical course and prognosis:2 cases received intravenous thrombolysis and signiifcantly improved, 1 case received arterial thrombolysis and signiifcantly improved, 2 cases refused thrombolysis but got spontaneous remission, 3 cases with mild symptoms got spontaneous remission without thrombolysis, 2 cases exceeding 3-hour window didn't receive thrombolysis due to normal perfusion-weighted imaging (PWI), 1 case exceeding 3-hour window didn't receive thrombolysis due tonormal diffusion-weighted imaging (DWI) and PWI. In all, there were 5 cases with definite infarction focus on the imaging. In the 3 patients thrombolysed with recombinant tissue-type plasminogen activator (rt-PA), based on Trial of Org 10172 in Acute Stroke Treatment (TOAST) classiifcation criteria, 2 cases (66.7%) were attributed to large artery atherosclerosis, 1 cases (33.3%) were attributed to small artery occlusion. All the 8 patients who were excluded from or refused thrombolysis, were attributed to small artery occlusion. Conclusion The prognosis of most of the alcohol-triggered cerebral infarction is good. Alcohol-triggered cerebral infarction may benefit from thrombolysis. Cause of most patients was small artery occlusion. A small part attributes to large artery atherosclerotic occlusion.