机械碎栓结合重组组织型纤溶酶原激活剂动脉溶栓后急性脑梗死患者的临床预后分析及多模式CT评估

Clinical prognosis of patients with acute cerebral infarction treated by mechanical embolus disruption combined with recombinant tissue plasminogen activator artery thrombolysis and its multimodal CT evaluation

目的：观察多模式CT对DSA指导下的机械碎栓结合rt-PA动脉溶栓治疗急性脑梗死临床诊断及预后疗效的评估。方法：收集2013年1月至2015年6月收治的经多模式CT筛选出的符合溶栓条件的急性脑栓塞患者30例,年龄38~78岁,平均65岁;病程0.5~6 h。将患者分为〈3 h组,16例;3~6 h组,14例。均经多模式CT诊断及评估后,行DSA指导下机械碎栓结合rt-PA动脉溶栓治疗。术后均再次行多模式CT评估血管再通情况并记录溶栓前后NIHSS评分、改良Rankin评分（MRS）及巴塞尔指数（BI）。结果：30例患者的血管再通率达到60%。NIHSS评分显示,〈3 h组患者有5例基本痊愈,7例显著进步,总显效率达到75.0%;3~6 h组的患者有3例基本痊愈,5例显著进步,总显效率为57.1%。两组比较,差异无统计学意义（P〉0.05）。MRS及BI评分显示,〈3 h组有12例临床结局良好,4例临床结局不良,10例预后结果良好,无出血病例;3~6 h组有6例临床结局良好,7临床结局不良,9例预后结果良好,1例症状性脑出血。两组比较,安全性及有效性差异均无统计学意义（P〉0.05）。结论：多模式CT诊断及评估机械碎栓结合rt-PA动脉溶栓治疗急性脑梗死是一种安全、有效、可行的方法,该法对于患者的临床预后分析具有一定的指导意义。

Objective： To observe the clinical prognosis and curative effect of patients with acute cerebral infarction treated by mechanical embolus disruption combined with rt-PA artery thrombolysis under the guidance of muhimodal CT evaluation. thrombolysis according to the an average of 65. The course Methods： Thirty patients with acute cerebral infarction who were feasible for multimodal CT evaluation were collected. Their age ranged from 38 to 78 years old with of the disease was 0. 5-6 hours. The patients were divided into two groups： 〈3 h group（ 16 cases）, and 3-6 h group（ 14 cases）. The two groups were treated by mechanical embolus disruption combined with rt-PA artery thrombolysis under the guidance of multimoda~ CT evaluation. The ,qascular recanalization was assessed and the NIHSS score, MRS score and BI score were documented before and after thrombolysis. Results： The vascular recanalization rate of the 30 cases reached 60%. The NIHSS score showed that 5 cases were basically cured and 7 cases had significant progress with the total efficiency of 75.0% in the 〈 3 h group. Three cases were basically cured and 5 had significant progress with the total efficiency of 57. 1% in the 3-6 h group. Comparison of the clinical curative effect between the two groups showed no significant difference （ P 〉 0.05 ）. The MRS and BI score showed that the clinical outcome was good in 12 cases and poor in 6 cases in 〈 3 h group and that the prognosis was good in 10 cases with no hemorrhage occurrence. The clinical outcome was good in 6 cases and poor in 7 in 3-6 h group. The prognosis was good in 8 cases and symptomatic cerebral hemorrhage occurred in ! case. No significant difference of the safety and effectiveness was found between the two groups （P 〉 0. 05 ）. Conclusion： Treating the patients with acute cerebral infarction by mechanical embolus disruption combined with rt- PA artery thrombolysis under the guidance of multimodal CT evaluation is safe, effective and feasible, which has certain guiding significance in the analysis of clinical prognosis in patients with acute cerebral infarction.