心源性脑栓塞超急性期静脉溶栓治疗的研究进展

Advances of intravenous thrombolytic therapy in hyperacute cardiogenic cerebral embolism

脑栓塞发病急骤、脑缺血坏死面积大、神经功能损害较严重,病情可在短时间内快速进展到高峰。脑栓塞发病后,脑血流突然中断,加上侧支循环代偿不足,脑细胞不可逆的死亡严重,从而使得该病的残疾率、病死率极高。脑栓塞最理想的治疗目的是早期使闭塞的脑血管再通。在起病3 h内的心源性脑栓塞患者进行静脉溶栓治疗是可行的,美国国立卫生研究院卒中量表(NIHSS)评分越低溶栓效果越佳,发生出血的几率也越小。而发病时间>3 h者或NIHSS评分>20分者,出血风险大,疗效欠佳,需慎重考虑。除严格掌握适应证和禁忌证外,溶栓前可行SITS SICH风险评分和多模式核磁共振(T1、T2、DWI、PWI及SWI)进行出血风险评估。此外,降低血压变异率,可降低溶栓后脑出血的风险。该文对心源性脑栓塞超急性期静脉溶栓治疗的研究进展作一简要的综述。

Cerebral embolism is a serious condition, resulting in a large infarct size and progressing rapidly in a short time.Embolism causes a sudden interruption of blood flow which leads to sufficient collateral circulation in the brain tissues, and dead brain cells.Cerebral embolism leads to massive cerebral infarction, high morbidity and high mortality.The best treatment of cerebral embolism is to make occlusive cerebral artery recanalization at the early stage.It is feasible to carry out intravenous thrombolytic therapy within 3 h of the onset of cardiogenic cerebral embolism in patients.The lower the score of national institutes of health stroke scale（ NIHSS） , the better the thrombolytic effect and the lower the probability of occurrence of cerebral hemorrhage.If the onset time 〉3 h or NIHSS score 〉20 points, thrombolysis should be cautious, because these situations are prone to cerebral hemorrhage.Thrombolysis should be performed strictly according to its indications and contraindications.It is necessary to use SITS SICH risk score and multimodal magnetic resonance imaging（T1, T2, DWI, PWI, SWI） to assess the risks of cerebral hemorrhage before doing thrombolysis.In addition, reducing blood pressure variability may reduce the risk factors of intrac-erebral hemorrhage after thrombolysis.