急性脑梗死动脉溶栓血管再通后的脑水肿研究

A clinical study on cerebral edema of intra-arterial thrombolytic recanalization in acute ischemic stroke

目的观察急性缺血性脑卒中动脉溶栓血管再通后脑水肿的发生、演变及转归。方法2010年10月至2012年10月于该院就诊，通过动脉溶栓血管再通的患者共36例。将患者分为1～3h组、〉3～6h组。头颅cT监测、随访脑水肿情况。记录溶栓前、术后1周及1年的美国国立卫生研究院卒中量表（NIHSS）、溶栓后1年改良蓝金评分（MRs）及巴塞尔指数（BI）。结果动脉溶栓血管再通后脑水肿的发生率为94％，出现在1～3h组、〉3～6h组的所有患者中，长期随访表明，脑水肿局部出现了明显的软化灶。两组患者脑水肿及临床结局比较差异无统计学意义（P〉0．05）。结论动脉溶栓血管再通后脑水肿的发生及其脑组织缺失几乎不可避免，良好的脑内局部循环及良好的全身状况是使此类脑水肿逐渐减轻的有利因素。

Objective To observe the cerebral edema occurrence,evolution and prognosis of intra-arterial thrombolytic recanali- zation in patients with acute ischemic stroke. Methods From October 2010 to October 2012,36 patients who underwent the intra- arterial thrombolytic therapy were cerebral recanalization. They were randomly divided into two groups： 1--3 h group and 〉3--6 h group. The alteration of brain edema was observed by cranial CT. Their mRS. NHISS and BI were scaled and recorded before and after intra-arterial thrombolytic therapy. Results After intra-arterial thrombolytic therapy, the occurrence rate of cerebral edema was 94 %,appeared at the onset of more than 1 hours in all patients. Long-term follow-up showed,cerebral edema location appeared obvious cerebromalacia. Cerebral edema and clinical outcome had not significant difference between 1--3 h group and 3--6 h group. Conclusion Cerebral edema and loss of cerebral tissue occurred almost inevitability in patients who received intra-artery thromboly- sis and recanalized their cerebral artery. It indicates that good local circulation and general condition may be favorable factors that can gradually reduce brain edema.