经颅多普勒超声持续监测辅助阿替普酶动脉溶栓治疗急性脑梗死的疗效观察

Effect of alteplase intra-arterial thrombolysis combined with continuous monitoring of transcranial Doppler in patients with acute cerebral infarction

目的观察经颅多普勒超声（TCD）持续监测辅助阿替普酶动脉溶栓治疗急性脑梗死的疗效。 方法将54例急性脑梗死患者按随机数字表法分为TCD组和对照组，两组均予阿替普酶动脉溶栓治疗；TCD组在此基础上予TCD持续监测。采用美国国立卫生研究院卒中量表（NIHSS）评分和Barthel指数（BI）评估患者神经功能缺损的程度，根据TCD检查血流信号的改变判断血管再通情况，溶栓后1 d内采用CT检查判断有无颅内出血等不良反应。比较两组患者神经功能缺损程度、溶栓后血管再通率及再通时间、脑出血等不良反应发生率。 结果两组溶栓前和溶栓后1 h NIHSS评分比较差异无统计学意义（P〉0.05）；TCD组溶栓后7、30 d NIHSS评分明显低于对照组[（8.1 ± 4.9）分比（12.1 ± 4.2）分和（6.9 ± 3.1）分比（10.9 ± 3.9）分]，差异有统计学意义（P〈0.05）。TCD组溶栓后7、30 d BI明显高于对照组[（78.5 ± 13.8）分比（60.8 ± 12.4）分和（82.6 ± 13.5）分比（63.2 ± 12.9）分]，差异有统计学意义（P〈0.05）。TCD组溶栓后24 h血管再通率明显高于对照组[70.4%（19/27）比44.4%（12/27）]，溶栓后再通时间明显短于对照组[（36.4 ± 9.5）min比（58.5 ± 12.4）min]，差异有统计学意义（P〈0.05）。两组溶栓后1 d内复查头颅CT，均未发现颅内出血等不良反应。 结论 TCD持续监测辅助阿替普酶动脉溶栓治疗急性脑梗死的疗效较好，且无明显不良反应。

Objective To observe the effect of alteplase intra-arterial thrombolysis combined with continuous monitoring of transcranial Doppler （TCD） in patients with acute cerebral infarction. Methods Fifty-four patients with acute cerebral infarction were divided into TCD group and control group by random digits table method. The patients of 2 groups were given alteplase intra-arterial thrombolysis, and the patients of TCD groups were combined with continuous monitoring of TCD. The degree of clinical neurologie impairment was evaluated by National Institutes of Health stroke scale （NIHSS） and Barthel index （BI）. The condition of vascular recanalization was evaluated by the change of blood flow signal of TCD. CT was performed within 1 d after thrombolysis to detect intracranial hemorrhage and other adverse reaction. The degree of clinical neurologic impairment, blood vessel recanalization rate after thrombolysis and recanalization time and incidence of intracranial hemorrhage and other adverse reaction were compared between 2 groups. Results There were no statistical difference in NIHSS score before thrombolysis and 1 h after thrombolysis between 2 groups （P 〉 0.05）. The NIHSS scores 7 and 30 d after thrombolysis in TCD group were significantly lower than those in control group： （8.1 ± 4.9） scores vs. （12.1 ± 4.2） scores and （6.9 ± 3.1） scores vs. （10.9 ± 3.9） scores, there were statistical differences （P 〈 0.05）. The BI scores 7 and 30 d after thrombolysis in TCD group were significantly higher than those in control group： （78.5 ± 13.8） scores vs. （60.8 ± 12.4） scores and （82.6 ± 13.5） scores vs. （63.2 ± 12.9） scores, and there were statistical differences （P 〈 0.05）. The blood vessel recanalization rate 24 h after thrombolysis in TCD group was significantly higher than that in control group： 70.4% （19/27） vs. 44.4% （12/27）, the recanalization time after thrombolysis was significantly shorter than that in control group： （36.4± 9.5） min vs. （58.5 ± 12.4） min, and there were statistical differences （P 〈 0.05）. No adverse reaction like intracranial hemorrhage and so on was found by CT detection within 1 d after thrombolysis in the 2 groups. Conclusions Alteplase intra-arterial thrombolysis combined with continuous monitoring of TCD in acute cerebral infarction has good curative effect, and no obvious adverse reaction.