经颅多普勒超声持续监测辅助尿激酶动脉溶栓治疗急性脑梗死的疗效观察

Observation of curative effects of urokinase intra-arterial thrombolysis combined with continuous monitoring of transcranial doppler on acute cerebral infarction

目的观察经颅多普勒超声（TCD）持续监测辅助尿激酶动脉溶栓治疗急性脑梗死的疗效。方法 28例急性脑梗死患者随机分为TCD组和对照组。两组均予以尿激酶动脉溶栓治疗;TCD组在此基础上予以TCD持续监测。根据TCD检查血流信号的改变判断血管再通情况;采用美国国立卫生研究院卒中量表（NIHSS）评分和Barthel指数（BI）评估患者神经功能缺损的程度。治疗后3 d内采用CT检查判断有无颅内出血等不良反应。结果治疗后30 d、90 d时,TCD组NIHSS评分均明显低于对照组（均P〈0.05）;BI均明显高于对照组（P〈0.05~0.01）。TCD组治疗后24 h时血管再通率（78.6%）明显高于对照组（30.8%）（P〈0.05）,治疗后再通时间[（34.5±10.5）min]明显短于对照组[（55.8±13.6）min]（P〈0.01）。两组治疗后3d内CT检查均未发现颅内出血等不良反应。结论 TCD持续监测辅助尿激酶动脉溶栓治疗急性脑梗死的疗效较好,且无明显不良反应。

Objective To observe the curative effects of urokinase intra-arterial thrombolysis combined with continuous monitoring of transcranial doppler（TCD） on acute cerebral infarction.Methods Twenty-eight patients with acute cerebral infarction were randomly divided into TCD group and control group.The therapy of urokinase intra-arterial thrombolysis was used to treat the patients of the two groups.And the patients of TCD group were given continuous monitoring of TCD.The condition of vascular recanalization was judged by the change of blood flow signal of TCD.The degree of neurologic impairment was evaluated by National Institutes of Health Stroke Scale（NIHSS） and Barthel index（BI）.During 3 d after the treatment,CT was used to detect whether there be adverse reaction like intracranial hemorrhage or not.Results At 30 d,90 d after the treatment,the NIHSS scores of TCD group were significantly lower than control group（all P0.05）;while the BI were significantly higher than control group（P0.05-0.01）.The vascular recanalization rate of TCD group（78.6%） at 24 h after the treatment was significantly higher than control group（30.8）（P0.05）.And the vascular recanalization time of TCD group [（34.5±10.5）min] after treatment was significantly shorter than contral group [（55.8±13.6）min]（P0.01）.No adverse reaction like intracranial hemorrhage and so on was found by CT detection during 3 d after the treatment in the two groups.Conclusion The curative effects of urokinase intra-arterial thrombolysis combined with continuous monitoring of TCD on acute cerebral infarction is good,and there is no obvious adverse reaction.