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经颅多普勒超声对脑梗死患者rt-PA溶栓中痫性发作的评价研究 被引量:15

Study on Evaluation of Transcranial Doppler for Cerebral Infarction Patients with Epileptic Seizures During r-tissue-type Plasminogen Activator Thrombolysis
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摘要 目的探讨脑梗死患者r-组织型纤溶酶原激活物(rt-PA)溶栓过程中继发痫性发作的经颅多普勒(TCD)影像学特点,分析痫性发作的危险因素。方法选取120例脑梗死患者作为研究对象,所有患者均接受rtPA溶栓治疗,其中继发痫性发作53例(痫性发作组),未继发痫性发作67例(单纯脑梗死组)。对比两组患者的TCD影像学特点。对所有患者的临床资料进行单因素Logistic回归分析和多因素Logistic回归分析。结果经TCD检查,痫性发作组颅内动脉狭窄、不全或闭塞率为30.19%,侧支循环不良率为73.58%;单纯脑梗死组颅内动脉狭窄、不全或闭塞率为23.88%,侧支循环不良率为29.85%。痫性发作组的侧支循环显著差于单纯脑梗死组(P<0.05)。痫性发作组血流速度异常率为69.81%,单纯脑梗死组血流速度异常率为32.84%,两组比较差异显著(χ2=69.20,P<0.01)。单因素Logistic分析显示,缺血部位、NIHSS评分与痫性发作呈相关性(P<0.05)。多因素Logistic分析表明,皮质缺血、NIHSS评分高为痫性发作的危险因素(P<0.05)。结论皮质缺血及NIHSS评分高的脑梗死患者易继发痫性发作;在rt-PA溶栓过程中宜用TCD检查侧支循环及血流速度,评断脑部血管狭窄程度,可作为服用抗癫痫药物治疗的依据。 Aim To evaluate the imaging features of transcranial Doppler( TCD) in cerebral infarction patients with epileptic seizures during r-tissue-type plasminogen activator( rt-PA) thrombolysis and analyze the risk factors of epileptic seizures. Methods 120 patients with cerebral infarction were selected to the research subjects. All patients received the rt-PA thrombolytic therapy. According to the occurrence of the epileptic seizures,the patients were divided into two groups: epileptic seizures group( 53 cases) and simple cerebral infarction group( 67 cases). The imaging features of TCD were compared between two groups. The correlations of the clinical factors to the occurrence of the epileptic seizures were analyzed by univariate Logistic regression analysis and multivariate Logistic regression analysis. Results TCD examination results showed that the intracranial arterial stenosis,incomplete or occlusion rate was 30. 19% and the poor collateral circulation rate was 73. 58% in epileptic seizures group. And the intracranial arterial stenosis,incomplete or occlusion rate was 23. 88% and the poor collateral circulation rate was 29. 85% in simple cerebral infarction group. The collateral circulation in epileptic seizures group was significantly worse than that in simple cerebral infarction group( P 0.05). The rate of abnormal blood flow velocity was 69. 81% in epileptic seizures group,and 32. 84% in simple cerebral infarction group,and the difference was significant between the two groups( χ2= 69. 20,P〈0. 01). Univariate Logistic analysis showed that the ischemic site and NIHSS score were correlated with epileptic seizures( P〈0.05). Multivariate Logistic analysis showed that the cortical ischemia and high NIHSS score were risk factors of epileptic seizures( P〈0.05).Conclusions The cortical ischemia and high NIHSS score were the susceptible factors to cerebral infarction patients with secondary epileptic seizures. In the course of rt-PA thrombolysis,TCD should be applied to inspect the collateral circulation and blood flow velocity and judge the degree of cerebral vascular stenosis,which is as a basis for the treatment of antiepileptic drugs.
出处 《中国动脉硬化杂志》 CAS 北大核心 2016年第7期701-704,共4页 Chinese Journal of Arteriosclerosis
基金 湖南卫生和计划生育委员会科研立项(B2015-55)
关键词 经颅多普勒 脑梗死 r-组织型纤溶酶原激活物 溶栓 痫性发作 Transcranial Doppler Cerebral Infarction r-Tissue-type Plasminogen Activator Thrombolysis Epileptic Seizures
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