经颅多普勒辅助脑梗死溶栓治疗的临床研究

Clinical Study of Transcranial Doppler Assisted Cerebral Infarction Thrombolytic Therapy

目的:研究经颅多普勒(TCD)联合r-t PA静脉溶栓(简称溶栓)治疗大脑中动脉脑梗死的有效性和安全性。方法:选取2013年2月-2014年9月在大连市友谊医院神经内科住院的大脑中动脉急性期脑梗死且符合溶栓标准的患者62例,分为试验组和对照组,试验组予溶栓联合TCD监测2 h,对照组予溶栓治疗。比较两组血管再通率、2周和3个月神经功能缺损(NIHSS、BI指数)、并发颅内出血和死亡情况。结果:试验组血管再通率显著高于对照组(60.0%vs 34.3%),其2周和3个月时的神经功能缺损程度(NIHSS、BI指数)均较对照组显著改善;联合TCD也造成颅内出血和直接相关死亡率的增加,但症状性颅内出血同对照组比较差异无统计学意义。结论:TCD联合溶栓治疗在血管再通率,短、中期的神经功能恢复方面均优于单纯溶栓,且死亡率两组相当,是安全有效的措施。

Objective：To study the efficiency and safety of TCD assisted r-tPA intravenous thrombosis to treat patient with middle artery infraction.Method：62 patients with acute ischemic middle artery infraction divided into experimental and control group.Experimental group was monitored by TCD within 2 h of thrombolysis and the control group was treated with thrombolytic therapy.Comparison of two groups of vascular recanalization rate,2 weeks and 3 months of neural function defect（NIHSS,BI index）,complicated with intracranial hemorrhage and death.Result：The recanalization rate of experimental group was significantly higher than the control group（60.0% vs 34.3%）.Besides, the degree of neural functional defect of experimental group was greatly improved than the control group.Combined with TCD also resulted in an increase of intracranial hemorrhage and directly related mortality,but there is no significant difference between two groups.Conclusion：The recanalization rate and recovery of neurological function of TCD combined with thrombolytic therapy are much better than intravenous thrombosis, while the mortality is equal in two groups.