阿替普酶治疗脑桥预警综合征1例及文献复习

Report and literature review of 1 cases of pontine warning syndrome treated by alteplase

目的观察1例脑桥预警综合征患者阿替普酶治疗的效果,分析内囊预警综合征、脑桥预警综合征的早期诊断,了解其可能发病机制,分析在联合治疗的基础上行阿替普酶静脉溶栓治疗的安全、可行性。方法结合相关文献分析1例脑桥预警综合征患者的临床症状、实验室检查、诊断和治疗。结果脑桥预警综合征是内囊预警综合征的亚型,大动脉血管狭窄可能是内囊预警综合征的病因之一,其脑梗死的转归风险高,合并椎动脉发育不全及中重度大动脉血管狭窄患者的症状发作频繁及神经功能障碍重,抗血小板聚集、抗凝、扩容、调脂、静脉溶栓等单一治疗内囊预警综合征疗效不佳,在联合治疗的基础上,静脉溶栓治疗安全、可行。结论内囊预警综合征是短暂性脑缺血发作的一种特殊亚型,脑桥预警综合征是其另一种表现形式,静脉溶栓和多药联合治疗安全、有效。

Objective To observe the effect of alteplase in the treatment of a patient with cerebral bridge early warning syndrome,to analyze the early diagnosis of internal balloon early warning syndrome and cerebral bridge early warning syndrome,understand its possible pathogenesis,and to explore the safety and feasibility of intravenous thrombolytic therapy with alteplase on the basis of combination therapy. Methods Combined with relevant literature,the clinical symptoms,laboratory examination,diagnosis and treatment of a patient with cerebral early warning syndrome were analyzed. Results The pontine warning syndrome is the subtype of capsular warning syndrome,its mechanism is complex,the large artery angiostenosis may also be one of the causes of capsular warning syndrome,the risk of cerebral infarction is high,patients with apsular warning syndrome associated with vertebral artery hypoplasia and moderate to severe large artery angiostenosis,frequent episodes of symptoms and severe neurological dysfunction,single treatment of capsular warning syndrome through antiplatelet aggregation,anticoagulant,expanded blood volume,lipid regulation,intravenous thrombolysis,poor efficacy,intravenous thrombolytic therapy is safe and feasible on the basis of combined treatment. Conclusion The capsular warning syndrome is a special subtype of transient ischemic attack,the pontine warning syndrome is its another manifestation,intravenous thrombolytic therapy and multidrug combined treatment is safe and effective.