256层CT指导下超时间窗静脉溶栓对急性缺血性脑卒中患者疗效及预后的影响

Effect of 256-slice CT Guiding on Efficacy and Prognosis of Intravenous Thrombolysis beyond Optimal Time-window in Patients with Acute Ischemic Stroke

目的分析256层CT指导下超时间窗静脉溶栓对急性缺血性脑卒中(AIS)患者疗效及预后的影响。方法回顾性分析2018年1月至2019年9月保定市第一中心医院收治的83例AIS患者的临床资料,根据溶栓治疗方案不同分为对照组(41例)和观察组(42例)。对照组采用阿替普酶(0.9 mg/kg)进行溶栓治疗;观察组在256层CT指导下确认无梗死、出血征象后再行阿替普酶溶栓治疗。观察并对比两组血管再通情况,溶栓前后美国国立卫生研究院卒中量表(NIHSS)评分及临床疗效,脑血流动力学指标[脑部收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)]变化,溶栓安全性,随访并对比两组的死亡率。结果观察组患者血管再通良好率高于对照组[83.33%(35/42)比46.34%(19/41)](χ^(2)=12.489,P<0.001)。治疗后,观察组NIHSS评分低于对照组[(7.23±1.97)分比(9.27±2.09)分](P<0.01)。观察组总有效率高于对照组[83.33%(35/42)比60.98%(25/41)](χ^(2)=5.177,P=0.022)。治疗后,观察组PSV、EDV高于对照组[(52.14±8.28)cm/s比(46.72±8.13)cm/s、(42.33±0.36)cm/s比(38.44±0.25)cm/s](均P<0.01)。两组患者总并发症发生率比较差异无统计学意义(P>0.05)。两组患者住院期间和出院后3个月死亡率比较差异无统计学意义(P>0.05)。结论256层CT指导下超时间窗静脉溶栓治疗AIS的临床疗效确切,可改善血管再通情况,且安全性高。

Objective To analyze the effect of 256-slice CT guiding on the efficacy and prognosis of patients with acute ischemic stroke(AIS)undergoing intravenous thrombolysis beyond optimal time-window.Methods The clinical data of 83 AIS patients admitted to Baoding First Central Hospital from Jan.2018 to Sep.2019 were retrospectively analyzed.According to their thrombolytic treatment plan,they were divided into a control group(41 cases,treated with 0.9 mg/kg of alteplase for thrombolysis)and an observation group(42 cases),which were performed 256-slice CT scan to confirm the absence of infarction and bleeding signs before administering alteplase thrombolytic therapy.The vascular recanalization,National Institute of Health stroke scale(NIHSS),clinical efficacy,cerebral blood flow indexes[peak systolic velocity(PSV),end diastolic velocity(EDV)]before and after thrombolysis in the two groups were observed and compared;the safety of thrombolysis in the two groups,as well as the mortality of the two groups were followed up and compared.Results The good recanalization rate of the observation group was higher than that of the control group[83.33%(35/42)vs 46.34%(19/41)](χ^(2)=12.489,P<0.001).After treatment,NIHSS score of the observation group was lower than that of the control group[(7.23±1.97)vs(9.27±2.09)](P<0.01).The total effective rate of the observation group was higher than that of the control group[83.33%(35/42)vs 60.98%(25/41)](χ^(2)=5.177,P=0.022).After treatment,PSV and EDV in the observation group were higher than those in the control group[(52.14±8.28)cm/s vs(46.72±8.13)cm/s,(42.33±0.36)cm/s vs(38.44±0.25)cm/s](all P<0.01).There was no significant difference in the incidence of total complications between the two groups(P>0.05).There was no significant difference in mortality between the two groups during hospitalization and 3 months after discharge(P>0.05).Conclusion The 256-slice CT scan guiding the intravenous thrombolysis treatment of AIS patients beyond optimal time-window has definite clinical effect,which can improve the recanalization with high safety.