急性前循环脑梗死静脉溶栓患者TIBI分级与血管再通和预后的相关性研究

The Correlation Study on Thrombolysis in Brain ischemia Flow Grades with the Recanalization and Outcomes of Acute Anterior Circulation Ischemic Stroke Patients Treated with Intravenous Recombinant Tissue Plasminogen Activator

目的静脉溶栓期间利用经颅多普勒超声(TCD)监测脑缺血溶栓血流(thrombolysis in brain ischemia,TIBI)分级,评估急性前循环脑梗死患者静脉溶栓治疗效果,血管再通情况及预后。方法选择急性前循脑梗死行阿替普酶静脉溶栓治疗的患者,于溶栓开始时行TCD监测并记录病变血管TIBI分级。发病72 h内患者通过头部磁共振血管成像(MRA)或复查TCD评价血管再通情况,比较TIBI分级与血管再通的相关性。采用美国国立卫生研究院卒中量表(NIHSS)评分记录患者溶栓前及溶栓后24 h临床神经功能缺损,3 m随访时采用改良Rankin量表(mRS)评分评估预后,分析前循环脑梗死患者静脉溶栓时血管情况与神经功能缺损程度、短期改善程度、血管再通情况及3 m预后的关系。结果溶栓时TIBI分级与24 h NIHSS评分均呈负相关关系(r=-0.407,P=0.005)。TIBI分级、基线NIHSS评分、早期神经功能改善、血管再通是90 d良好预后的独立预测因素(TIBI分级:OR2.147,95%CI,1.332~3.460,P=0.002;基线NIHSS评分:OR0.876,95%CI,0.774~0.992,P=0.037;早期神经功能改善:OR11.917,95%CI,2.826~50.246,P=0.01;血管再通:OR 8.95%CI,1.65~38.79,P=0.01)。结论急性前循环脑梗死患者阿替普酶静脉溶栓治疗时TIBI血流分级,能够有效反映溶栓治疗效果并有助于判断预后,TIBI分级越高患者预后越好,是静脉溶栓患者血管评估的重要手段。

Objective To investigate the relationship between thrombolysis in brain ischemia（ TIBI） transcranial Doppler flow grades and degree of neurological deficiency and outcome in patients with acute ischemic stroke in the anterior circulation treated with intravenous thrombolysis. Methods Acute anterior cerebral infarction patients who received alteplase intravenous thrombolysis therapy were enrolled. TIBI flow grades during the thrombolysis were assessed. Recanalization of the intravenous treated patients were evaluated by MRA or TCD. National Institutes of Health Stroke Scale（ NIHSS）was evaluated to record the neurological deficiency on the baseline and 24 hours after administration of t PA thrombolysis.The modified Rankin Scale（ mRS） was evaluated on 3 months follow-up. Association between TIBI flow grades and National Institute of Health Stroke Scale（ NIHSS） scores and modified Rankin Scale（ mRS） scores 90 d after the thrombolysis was evaluated. Results The TIBI flow grade was significantly correlated with the 24 h NIHSS scores（ r =-0. 407,P =0. 005 Spearman＇s ρ coefficient）. The TIBI flow grades,baseline NIHSS scores、early neurology function improvement、and vascular recanalization were independent predictors of good outcome 3 months after stroke（ odds ratio 2. 147,95% confidence interval,1. 332 - 3. 460,P = 0. 002; odds ratio 0. 876,95% confidence interval,0. 774 - 0. 992,P = 0. 037; odds ratio11. 917,95% confidence interval,2. 826 - 50. 946,P = 0. 01; odds ratio 8. 95% confidence interval,1. 65 - 38. 79,P =0. 01）. Conclusion TIBI flow grades during t PA thrombolysis is correlated with stroke severity and outcome in patients with ischemic stroke of anterior circulation.