以TIA为临床表现的急性脑梗死溶栓观察

Observation of Thrombolysis on Acute Cerebral Infarction with Clinical Symptoms like

目的研究静脉rt-PA溶栓治疗对以TIA为临床表现的急性脑梗死患者预后的影响。方法选择2010—2013年于天津环湖医院神经内科住院的以TIA为临床表现的急性脑梗死患者34例经静脉rt—PA溶栓治疗作为试验组，并选择2010年前于我院住院未行溶栓治疗的以TIA为临床表现的急性脑梗死患者32例作为对照组，分析比较溶栓治疗对以TIA为临床表现的急性脑梗死患者预后影响。结果发病7d时试验组13例（38．24％）DWI转为阴性，未进展为脑梗死，20例（58．82％）为不可逆性脑梗死，其中4例仍有TIA发作，而对照组5例（15．63％）DWI转为阴性，未进展为脑梗死，27例（84．38％）为不可逆性脑梗死，5例仍有TIA发作。同时将两组患者发病时及发病24h、7d、14d的NIHSS评分进行比较，试验组NIHSS南发病时13．35±1．63分，下降至14d时2．83±1．12分，对照NIHSS组南发病时13．16±2．07分，下降至14d时5．36±1．89分。两组梗死体积也有明显差异，试验组梗死体积5．46±1．63ml，对照组梗死体积9．38±2．16ml。结论以TIA为临床表现的急性脑梗死应积极考虑溶栓治疗。

Objective To study the prognosis of intravenous rt-PA thrombolytic therapy on patients of acute cere- bral infarction with TIA as clinical symptoms. Methods 34 acute cerebral infarction patients with TIA as clinical symp- toms treated by intravenous rt-PA tbrombolytic therapy were choosen in department of neurology of tianjin huanhu hospital from 2010 to 2013 as the experimental group,32 patients of acute cerebral infarction with TIA as clinical symptoms before 2010 without thrombolytic therapy were selected in our hospital as control group. The prognosis of tbrombolytic therapy was analysed and compared. Results 13 cases （38.24%） did not progress to infarction,20 cases （58.82%） got irreversible cerebral infarction,4 cases still had clinical seizures at day7 in experimental group, while in the control group,5 cases （ 15.63% ） did not progress to infarction,27 cases （84.38%） got irreversible cerebral infarction,and 5 patients still had clinical seizures. The NIHSS score of experimental group fell from 13.35 ± 1.63 points by the onset to 2.83 ± 1. 12 points at dayl4,while in the control group NIHSS fell from 13.16± 2.07 points by the onset to 5.36±1.89 points at dayl4. There were significant difference in infarct volume. Infarct volume of experimental group was 5.46±1.63ml,and control group was 9.38 ± 2.16ml. Conclusions In patients of acute cerebral infarction with TIA as clinical symptoms, infarction thrombolytic therapy should be actively considered.