超声助溶治疗急性大脑中动脉闭塞性脑梗死的临床研究

Clinical research on sonothrombolysis in acute infarction of middle cerebral artery occlusion

目的探讨经颅多普勒超声联合rt-PA静脉溶栓治疗急性大脑中动脉闭塞性脑梗死的有效性及安全性,同时探索超声助溶的合适时间。方法急性大脑中动脉闭塞性脑梗死患者73例,所有患者均行rt-PA静脉溶栓治疗,并按照超声助溶的时间随机分为3组,2 h超声助溶组24例、1.5 h超声助溶组25例和对照组24例。采用脑缺血溶栓血流分级判断血管再通情况,用美国国立卫生研究院卒中量表评分评估患者神经功能缺损程度,以溶栓后有无症状性颅内出血来评定其安全性,溶栓后3个月用改良Rankin量表及Barthel指数评分评定远期预后。结果 2 h助溶组与1.5 h助溶组治疗后2 h血管再通率以及治疗后3个月BI值显著高于对照组(P<0.05),而2助溶组之间血管再通率无明显差异(P>0.05);2 h助溶组与1.5 h助溶组治疗24 h后NIHSS评分、治疗后3个月mRS评分显著低于对照组(P<0.05),而2助溶组之间无明显差异(P>0.05);3组患者治疗后24 h均未出现症状性颅内出血。结论超声助溶治疗急性大脑中动脉闭塞性脑梗死安全、有效、远期预后良好,而针对于助溶时间选择上建议将时间缩短至1.5 h。

Objective To evaluate the efficacy and safety of transcranial Doppler ultrasonography （TcD） combined with recombinant tissue-type plasminogen activator （rt-PA） intravenous thrombolysis in a- cute infarction of middle cerebral artery occlusion therapy, and explore the appropriate time of sonothrombolys- is. Methods The acute infarction of middle cerebral artery occlusion patients （75 cases）, who received rt-PA intravenous thrombolysis, were randomly divided into 3 groups：2 h sonothrombolysis group （24 cases） accord- ing to sonothrombolysis time, 1.5 h sonothrombolysis group （25 cases） and control group （24 cases without sonothrombolysis）. Artery recanalization was analyzed by TIBI rating, the degree of neurological functional im- pairment was evaluated by National Institutes of Health Stroke Scale （NIHSS） score. After thrombolysis, the safety was evaluated by symptomatic intracranial hemorrhage, and after thrombolysis 3 months, the long term prognosis was evaluated by mRS and Barthel index （BI） score. Results Compared to control group,2 h sono- thrombolysis group and 1.5 h sonothrombolysis group showed significantly increased artery recanalization rate after 2 h therapy and BI score after 3 month therapy （P〈0. 05）, also showed significantly decreased NIHSS score after 24 h therapy and mRS score after 3 month therapy （P〈0. 05）, however, there were no difference between 2 h sonothrombolysis group and 1.5 h sonothrombolysis group. Besides, symptomatic intracranial hemorrhage didn＇t happen in 3 groups after 24 h therapy. Conclusion Sonothrombolysis is safe and effective for acute infarction of middle cerebral artery occlusion, and has a good long term prognosis. Moreover, it is sugges- ted that the appropriate time of sonothrombolysis should be shortened to 1.5 h.