CT灌注成像技术指导下急性脑梗死溶栓治疗的疗效评估

Effect of CTP guided thrombolytic therapy in the treatment of acute cerebral infarction

目的探讨CT灌注成像技术(CTP)指导下急性脑梗死溶栓治疗的效果。方法发病6 h内的急性脑梗死患者200例,溶栓前均行CTP检查,根据CTP检查结果,分为存在半暗带组和不存在半暗带组,用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓,观察2组患者溶栓前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)、改良Rankin量表(mRS)评分以及出血性转化等事件,评估2组患者治疗有效率、良好预后率。结果与不存在半暗带组(6.67±3.46)比较,存在半暗带组患者溶栓7 d后NIHSS评分明显降低(4.76±2.04),4周时降低最明显(3.68±1.93)。存在半暗带组4周时有效率(60.3%)、3个月时良好预后率(71.7%)均明显优于不存在半暗带组(34.7%,56.8%)。结论 CTP指导下rt-PA静脉溶栓治疗安全有效,可根据半暗带扩大溶栓治疗窗,并且出血转化率低。

Objective To investigate the effect of CT perfusion （CTP） imaging guidance in the treatment of acute cerebral infarction. Methods Patients （n=200） with acute cerebral infarction who visited our clinic within 6 hours underwent CTP examination and were divided into two groups：penumbra group and non-penumbra group according to their CTP imaging （presence of penumbra or not）. Recombinant tissue plasminogen activator （rt- PA） was administrated for intravenous thrombolysis in both groups. NIHSS （The NIH Stroke Scale）, BI （Barthel Index）, mRS （modified Rankin Scores） and hemorrhagic transformation events of two groups were determined before and after thrombolysis to evaluate its effect and prognosis in these two group. Results Compared with non penumbra group, NIHSS was reduced in penumbra group from 7 days after rt-PA （6.67±3.46 vs 4.76±2.04）, and this decrease became obvious at 4 weeks after rt-PA （6.67±3.46 vs 3.68±1.93）. Efficiency rate at 4 week （60.3%） and good prognosis rate at 3 months（71.7%）were both significantly improved in penumbra group than those in non penumbra group（34.7%,56.8%）. Conclusion rt-PA under CTP guidance is effective and safe in the treatment of acute cerebral infarction. The thrombolytic therapy window can be enlarged according to the presence of penumbra or not and the bleeding conversion rate remains at low level.