多模式核磁共振指导觉醒型缺血性卒中静脉溶栓治疗的临床价值

Clinical Value of Multimode Nuclear Magnetic Resonance Guided Intravenous Thrombolysis in Awake Ischemic Stroke

目的探讨多模式核磁共振指导觉醒型缺血性卒中(WUIS)静脉溶栓治疗的临床价值。方法纳入广东省梅州市人民医院神经内科2017年6月至2020年6月收治的WUIS患者65例,按随机数字表法分为对照组(32例)和观察组(33例),对照组患者根据多模式核磁共振(MRI)结果给予血小板抑制剂进行抗血小板治疗,以及应用自由基清除剂、保护神经药物等药物,观察组患者在多模式MRI指导下行尿激酶静脉溶栓治疗。对比两组的神经功能缺损情况、溶栓后出血情况、预后效果。结果治疗后24h、7d,观察组患者的美国国立卫生院卒中量表(NIHSS)评分均低于对照组(P<0.05),两组总出血发生率对比无统计学意义(P>0.05),两组治疗90d后mRS(0分或1分)的患者例数对比差异无统计学意义(P>0.05)。结论多模式MRI指导WUIS静脉溶栓治疗,可减轻患者的神经功能缺损,且不增加出血率,不影响预后效果。

Objective To investigate the clinical value of multimode nuclear magnetic resonance guided intravenous thrombolysis in awake ischemic stroke(WUIS).Methods Sixty-five WUIS patients admitted to the department of Neurology of our hospital from June 2017 to June 2020 were included and divided into the control group(32 cases)and the observation group(33 cases)according to the random number table method.The control group received conventional antithrombotic therapy,and the observation group received intravenous urokinase thrombolysis under the guidance of multi-mode magnetic resonance imaging(MRI).The neurological deficits,bleeding after thrombolysis,and prognosis of the two groups were compared.Results At 24h and 7d after treatment,the scores of National Institutes of Health Stroke Scale(NIHSS)in the observation group were lower than those in the control group(P<0.05),and the incidence of total bleeding in the observation group was lower than that in the control group(P<0.05).There was no significant difference in the number of patients whose mRS(0 or 1 point)or NIHSS score decreased≥8 points between the control group and the observation group after 90 days of treatment(P>0.05).Conclusion WUIS intravenous thrombolysis guided by multi-mode MRI can alleviate neurological deficits and reduce bleeding events in patients with good safety,but the prognosis of the two treatment methods is good.