磁共振血管成像评定静脉溶栓治疗急性脑梗死疗效的价值

Value of magnetic resonance angiography to evaluate the curative effect of venous thrombolysis for acute cerebral infarction

目的探讨磁共振血管成像(MRA)评定静脉溶栓治疗急性脑梗死(ACI)疗效的价值。方法对13例发病24h内入院的ACI患者应用尿激酶100万U静脉溶栓治疗;观察患者治疗前后临床神经功能评分情况;并对治疗前后MRA表现进行比较。结果13例ACI患者溶栓后欧洲卒中量表(ESS)评分(24h～90d,评分为62.6～88.9分)较治疗前(45.8分)明显提高(均P<0.0001),其中24h、72h(71.8分)增加最快,至14d评分最好者达100分,至90d可正常生活者5例。患者治疗前MRA均为大脑中动脉M1或M2段闭塞,远端血管不显影。静脉溶栓后MRA示血管完全再通4例(30.8%);9例较治疗前血管显影增多,但多呈纤细或断续显影。结论(1)静脉溶栓治疗ACI疗效确切,ESS评分明显增加。(2)ACI患者于治疗前后行MRA检查可以确切了解血管闭塞以及血管再通情况。

Objective To explore the value of magnetic resonance angiography（MRA） to evaluate the curative effect of venous thrombolysis for acute cerebral infarction（ACI）. Methods 13 ACI patients delivered into hospital in 24 h following ACI onset recived the therapy of venous thrombolysis with urokinase 1 million U . The score of clinical neurologic function was observed and the results of brain MRA were compared between pre and post treatment. Results The scores of European Stroke Scale （ESS） of the 13 patients 24 h -90 d（62.6 -88.9） were significantly increased compared with pre thrombolysis （45.8） （ all P 〈 0. 0001 ）. The scores of ESS were increased quickly in 24 h and 72 h （71.8） post thrombolysis. The best score in the patients Was l00 14 d post thrombolysis. After 90 d, 5 cases could living normally. MRA showed that middle cerebral arteries M1 or M2 of all the cases were occluded, outlying artery showed no image pre treatment. Post treatment, the vascular repeffusion complete were observed in 4 cases（30.8% ） with MRA; the image of the vessels were increased obviously, but most of them were thin or intermittent in other 9 cases. Conclusions （ 1 ） The therapy of venous thrombolysis for ACI is effective. The score of ESS has been improved remarkable. （2） MRA is a good method to observe the vascular occlusion and reperfusion pre and post ,thrombolysis in patient with ACI.