经颅多普勒超声对脑梗死溶栓治疗的观察

Transcranial Doppler Used in Middle Cerebral Artery StrokeTreated with Intravenous Thrombolytic Therapy

目的 应用经颅多普勒(TCD)观察大脑中动脉(MCA)供血区急性脑梗死患者溶栓前后的血流变化。方法 对于我科2001～2002年间行尿激酶或rt—PA静脉溶栓的患者进行溶栓前后的床旁TCD检查,采用TIBI血流信号分级法,将受累大脑中动脉血流信号分为六型:1.无血流型;2.微小血流型;3.圆钝型;4.衰减型;5.狭窄型;6.正常型。然后合并为3级:1、2型为Ⅰ级;3、4型为Ⅱ级;5、6型为Ⅲ级。同时评价溶栓前后的NIHSS评分。结果 符合条件者共49人,不同血流信号级别患者,NIHSS评分有显著性差异,且随着血流信号的改善,NIHSS评分亦有所下降。结论经颅多普勒在静脉溶栓时能协助了解脑血管血流情况,其血流改善与患者临床情况的改善密切相关。

Objective: Using transcranial Doppler (TCD) to observe related MCA bloodflow in stroke patients treated with intravenously thrombolytic therapy. Methods: TCD examinations were performed before and after intravenous thrombolytic therapy. TIBL flows were determined at distal MCA and basilar artetry depths, depending on occlusion site. TIBI waveforms were classified as follows : 1. absent; 2. minimal; 3. blunted; 4. dampened; 5. stenotic; and 6. normal. Then put into 3 grades; 1 and 2 belongs to grade 1,3 and 4 belongs to grade 1 ,5 and 6 belongs to grade Ⅲ. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and 6-12 hours after thrombolytic therapy. Resrlts: Fourty inne patients were studied. Median NIHSS score before thrombolysis was 15. The NIHSS scores of patoents presented with different TIBI grades were significantly different (P<0. 001). TIBI flow recovery correlated with NIHSS score improvement. Lack of flow recovery predicted worsening or no improvement. Conclusions: Emergent TCD can provide important information of cerebral bloodflow in ischemic patients. The classification correlates with initial stroke severity. A flow - grade improvement correlated with clinical improvement.