不同动脉供血区急性脑梗死患者不同时间窗动脉溶栓治疗的疗效观察

Therapeutic effect of arterial thrombolysis treatment in patients with acute cerebral infarction caused by different arteries occlusion and during different time windows

目的观察颈内动脉(ICA)、大脑中动脉(MCA)和椎-基底动脉(VBA)闭塞致急性脑梗死患者不同时间窗动脉溶栓治疗的疗效。方法分别对19例发病<6h及21例发病6～9h不同血管(ICA12例,MCA18例,VBA10例)闭塞患者,根据头颅磁共振灌注加权成像(PWI)/弥散加权成像(DWI)≥20%的急性脑梗死患者行动脉内超选择性重组组织型纤溶酶原激活物(r-tPA)溶栓治疗。治疗前后进行卒中量表(NIH-SS)评分,治疗后90d用修正Rankin量表(MRS)评价临床预后。结果溶栓后血管再通率:MCA组77.8%,VBA组50.0%,ICA组33.3%,3组间差异有统计学意义(均P<0.05)。发病<6h组和6～9h组患者溶栓治疗后NIHSS评分比治疗前明显改善(均P<0.05),两组间NIHSS的改善程度差异无统计学意义(P>0.05)。治疗后90d时预后良好率:MCA组77.8%,ICA组41.7%,VBA组30.0%,3组间差异有统计学意义(均P<0.05)。术后发生颅内出血4例,血管再闭塞1例。结论动脉溶栓治疗MCA闭塞的疗效最好,ICA闭塞次之,VBA闭塞较差。动脉溶栓时间窗<6h与6～9h的疗效无明显差异。提示对PWI/DWI不匹配的患者,动脉溶栓治疗时间窗可放宽到9h。

Objective To observe the efficacy of arterial thrombolysis treatment in patients with acute cerebral infarction caused by internal carotid artery(ICA),middle cerebral artery(MCA)and vertebrobasilar artery(VBA)occlusion and during different time windows.Methods In the 40 patients with different artery(12 ICA,18 MCA and 10 VBA)occlusions,19 patients with the time windows of <6 h and 21 patients between 6~9 h received superselective arterial thrombolysis with r-tPA when the mismatch of brain MR DWI/PWI was more than 20%.The nervous function recovery status was evaluated with NIHSS before and after the thrombolysis and the clinical prognosis was evaluated with Rankin scale(MRS).Results The recanalization rate showed in angiography:77.8%in MCA,50% in VBA and 33.3% in ICA.There were significant differences among these three groups(all P< 0.05).A remarkable NIHSS recovery was showed both in <6 h and 6～9 h time window groups(all P< 0.05),but no significant difference was found between the two groups(P>0.05).The rate of better prognosis at 90 d followed up with MRS demonstrated 77.8% in MCA,41.7% in ICA and 30.0% in VBA and there were significant difference among these three groups(all P< 0.05).Intracranial hemorrhage happened in 4 cases and reocclusion occured in 1 case after operation.Conclusion The efficacy of arterial thrombolysis is best in MCA,better in ICA and good in VBA and no significant difference between the time windows of <6 h and 6~9 h.The results revealed the time window for arterial thrombolysis treatment can be prolonged to 9 h when the mismatch of PWI/DWI is more than 20%.