TCD在急性缺血性脑卒中静脉溶栓中的应用价值

Application Value of TCD in Intravenous Thrombolysis of Acute Ischemic Stroke

目的探讨经颅多普勒超声(TCD)在急性缺血性脑卒中静脉溶栓中的应用价值。方法选取2021年8月-2022年5月在安徽医科大学附属巢湖医院接受rt-PA静脉溶栓的104例急性前循环脑梗死患者为研究对象,根据患者溶栓后7 d NIHSS评分的下降幅度分为A组57例(NIHSS评分减少46%~100%)和B组47例(NIHSS评分减少小于46%),两组溶栓后24 h行床旁TCD检查,记录双侧大脑中动脉搏动指数(PI);比较两组一般及临床资料,根据溶栓后7 d NIHSS评分将A组分为基本治愈、显效两个等级,将B组分为进步、无效2个等级,比较4个等级患者溶栓24 h后PI值,分析PI值与患者入院时、溶栓24 h后、7 d NIHSS评分的相关性。结果A、B组年龄、高血压史、房颤史比较,差异无统计学意义(P<0.05);两组糖尿病史、糖化血红蛋白水平比较,差异有统计学意义(P<0.05);基本治愈、显效、进步、无效4个等级PI值比较,差异有统计学意义(P<0.05);相关性分析显示,显效、无效患者的PI值与溶栓后24 h NIHSS评分有相关性(P<0.05),显效、进步、无效患者的PI值与溶栓后7 d NIHSS评分有相关性(P<0.05)。结论TCD对急性前循环脑梗死患者神经功能损伤的评估和恢复具有十分重要的指导意义,值得临床应用。

Objective To explore the application value of transcranial Doppler ultrasound(TCD)in intravenous thrombolysis of acute ischemic stroke.Methods A total of 104 patients with acute anterior circulation cerebral infarction who received rt-PA intravenous thrombolysis in Chaohu Hospital of Anhui Medical University from August 2021 to May 2022 were selected as the study subjects.According to the decrease of NIHSS score at 7 days after thrombolysis,the patients were divided into 57 cases in group A(NIHSS score decreased by 46%-100%)and 47 cases in group B(NIHSS score decreased by less than 46%).Bedside TCD examination was performed 24 hours after thrombolysis in both groups,and the pulsatility index(PI)of bilateral middle cerebral artery was recorded.The general and clinical data of the two groups were compared.According to the NIHSS score at 7 days after thrombolysis,group A was divided into two grades:basic cure and marked effect,and group B was divided into two grades:progressive and ineffective.The PI values of the four grades of patients after 24 hours of thrombolysis were compared,and the correlation between PI value and NIHSS score at admission,24 hours after thrombolysis and 7 days after thrombolysis was analyzed.Results There was no significant difference in age,history of hypertension and history of atrial fibrillation between group A and group B(P<0.05).There were significant differences in diabetes history and glycosylated hemoglobin level between the two groups(P<0.05).There were significant differences in PI values among the four grades of basic cure,marked effect,progress and ineffective(P<0.05).Correlation analysis showed that the PI value of patients with marked effect and ineffective was correlated with NIHSS score at 24 h after thrombolysis(P<0.05),and the PI value of patients with marked effect,improvement and ineffective was correlated with NIHSS score at 7 d after thrombolysis(P<0.05).Conclusion TCD has important guiding significance for the evaluation and recovery of neurological impairment in patients with acute anterior circulation cerebral infarction,which is worthy of clinical application.