经颅多普勒超声在缺血性脑卒中患者急诊溶栓治疗中的应用

Application of transcranial Doppler ultrasound in emergency thrombolytic therapy of ischemic stroke

目的探讨急性缺血性脑卒中患者溶栓前后脑缺血溶栓血流分级(TIBI)变化及与患者预后的相关性。方法选择2013年2月至2015年10月新疆医科大学第一临床医学院暨第一附属医院收治的急性缺血性脑卒中患者41例,均接受重组组织型纤溶酶原激活剂静脉溶栓治疗,采用经颅多普勒超声监测患者溶栓前后TIBI变化情况,评价溶栓前、溶栓后24 h、7~10 d TIBI与美国国立卫生研究院卒中量表(NIHSS)评分的相关性,以及溶栓后3个月TIBI与改良Rankin(mRS)评分的相关性。结果 41例患者溶栓前TIBI分级0~1级29例(70.7%),2~3级12例(29.3%),NIHSS评分分别为20(18,22)分、12(11,12)分;溶栓后24 h TIBI 0~1级8例(19.50%),2~3级15例(36.6%),4~5级18例(43.9%),NIHSS评分分别为18(16,19)、13(11,15)、10(8,11)分;溶栓前、溶栓后24 1h的TIBI与NIHSS评分均呈负相关(r=-0.793、-0.639,均P<0.001)。溶栓后7~10 d,TIBI与NIHSS评分呈负相关(r=-0.745,P<0.001);溶栓后3个月TIBI与mRS评分呈负相关(r=-0.600,P=0.001)。结论 TIBI与急性缺血性脑卒中所导致的神经功能缺损评分的变化具有相关性,可以反映溶栓效果,协助判断患者的预后。

Objective To analyze the relation between changes of thrombolysis in brain ischemia（TIBI） classification and prognosis in thrombolytic therapy for patients with acute ischemic stroke. Methods Forty-one patients with acute ischemic stroke were enrolled from February 2013 to October 2015 in the First Affiliated Hospital of Xinjiang Medical University. All patients had thrombolytic therapy with recombinant tissue plasminogen activator; changes of TIBI were monitored by transcranial Doppler sonography. Relations among pre-thrombolysis TIBI, 24 h and 7-10 d post-thrombolysis TIBI and score of the National Institutes of Health Stroke Scale（NIHSS） were analyzed; relation between 3-month post-thrombolysis TIBI and Score of the modified-Rankin Scale （mRS） was analyzed. Results In 41 patients before thrombolysis, there were 29 cases （70. 7% ） of TIBI grade 0-1 [ the NIHSS score =20（18,22）points] and 12 cases（29. 3% ） of TIBI grade 2-3[the NIHSS score = 12（ 11,12）points]. At 24 h after thrombolysis, there were 8 cases （ 19. 5% ） of TIBI grade 0-1 [ the NIHSS score = 18 （16,19） points ], 15 cases（36. 6% ） of TIBI grade 2-3 [ the NIHSS score = 13 （11,15 ）points ] and 18 cases （43.9%） of TIBI grade 4-5 [ the NIHSS score = 10 （ 8,11 ） points ] ： Pre-thrombolysis TIBI and 24 h post-thrombolysis TIBI were negatively related to the NIHSS score（ r = - 0. 793, - 0. 639 ; P 〈 0. 001 ） ; 7-10 d post-thrombolysi.s TIBI was negatively related to the NIHSS score （r = -0. 745, P 〈 0. 001 ）. Three-month post-thrombolysis TIBI was negatively related to the mRS score （ r = - 0. 600, P = 0. 001 ）. Conclusion TIBI classification is associated with neurologic impairment in patients with acute ischemic stroke; it is a good indicator of thrombolysis and prognosis.