经颅多普勒超声对大脑中动脉急性闭塞阿替普酶静脉溶栓血流分级的研究

Study of transcranial Doppler flow grades of thrombolysis in brain ischemia in patients with acute middle cerebral artery occlusion after alteplase treatment

目的应用经颅多普勒超声技术探讨大脑中动脉急性闭塞或狭窄后重组组织型纤溶酶原激活物阿替普酶静脉溶栓治疗前后血流分级变化,以及与神经功能缺损程度及预后之间的相关关系。方法分别于阿替普酶静脉溶栓治疗前和溶栓治疗后24h对狭窄或闭塞的大脑中动脉进行脑缺血溶栓血流(TIBI)分级。采用美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评价溶栓治疗后24h大脑中动脉TIBI分级与NIHSS和mRS评分之间的相关性。结果溶栓治疗前不同TIBI分级之间NIHSS评分差异有统计学意义(H=36.514,P=0.000),并且TIBI分级与NIHSS评分呈负相关关系(rs=0.737,P=0.000)。与溶栓治疗前相比,溶栓治疗后24h约47.17%(25/53)患者TIBI分级改善至4~5级(Z=5.262,P=0.000);神经功能恢复良好者71.70%(38/53)、不良者28.30%(15/53;Z=6.353,P=0.000)。溶栓治疗后第90天时,mRS评分提示疗效良好者67.92%(36/53)、疗效不良者32.08%(17/53),不同TIBI分级之间mRS评分差异有统计学意义(χ2=31.973,P=0.000),二者之间呈负相关(rs=0.683,P=0.001)。结论阿替普酶静脉溶栓治疗后,TIBI血流分级与大脑中动脉急性闭塞或狭窄患者神经功能缺损程度及其恢复程度相关,能够反映溶栓治疗效果并有助于判断预后。

Objective To investigate the relationship between changes of bloo d flow of acute mi d dle cerebral artery(MCA) occlusion or stenosis an d degree of neural function defect an d prognosis before an d after intravenous thrombolytic therapy with alteplase.Metho dsFifty three patients diagnose d as acute MCA stenosis or occlusion an d given alteplase intravenous thrombolysis therapy were enrolle d.Thrombolysis in brain ischemia(TIBI) flow gra des of MCA before an d 24 h after the thrombolysis were assesse d. The correlation between TIBI flow gra des an d National Institute of Health Stroke Scale(NIHSS)scores an d mo difie d Rankin Scale(mRS) scores 90 d after the thrombolysis was evaluate d.ResultsThere were significant differences in the NIHSS scores before intravenous thrombolytic therapy among different TIBI flow gra des(H = 36.514, P = 0.000). The TIBI flow gra de was negatively correlate d with the NIHSS scores before thrombolysis(rs= 0.737, P = 0.000), in dicating that lower TIBI gra de of MCA presente d the nerve function defect worse. Compare d with before thrombolytic therapy, there were 25 cases(47.17%)achieve d to gra de 4-5 of TIBI flow gra de of MCA 24 h after thrombolytic therapy, suggesting the recanalization of MCA(Z=5.262, P=0.000). In comparision with pre thrombolytic therapy, neural function of 38 cases(71.70%) recovere d well 24 h after treatment, an d the difference of NIHSS scores was statistically significant while that of 15 cases(28.30%) di d not obtain favorable recovery of neural function(Z= 6.353, P=0.000). There were significant differences in mRS scores 90 d after the thrombolysis among different TIBI flow gra des 24 h after the thrombolysis(χ2= 31.973, P = 0.000), an d they were negatively correlate d with each other(rs= 0.683, P = 0.001). Accor ding to mRS scores, 36 cases(67.92%) obtaine d favorable outcome but 17 cases(32.08%) was unfavorable 90 d after the therapy.ConclusionTIBI flow gra de is correlate d with neurological deficit an d its recovery in acute MCA occlusion or stenosis, which may reflect the efficacy of thrombolytic therapy an d help to pre dict the prognosis.