目的:探讨脑微出血(CMB)对小动脉闭塞型急性缺血性卒中患者rt-PA静脉溶栓后出血转化及预后的影响。方法:选择2018年1月至2020年2月在贵州医科大学附属医院神经内科进行rt-PA溶栓的小动脉闭塞型急性缺血性卒中患者作为研究对象,按有无CM...目的:探讨脑微出血(CMB)对小动脉闭塞型急性缺血性卒中患者rt-PA静脉溶栓后出血转化及预后的影响。方法:选择2018年1月至2020年2月在贵州医科大学附属医院神经内科进行rt-PA溶栓的小动脉闭塞型急性缺血性卒中患者作为研究对象,按有无CMB分为CMB阳性组与CMB阴性组,其中CMB阳性组根据CMB的个数分为低负荷组(1〜4个)和高负荷组CMB(≥5个)。所有患者均在时间窗内进行rt-PA静脉溶栓,并记录患者的一般临床资料。根据患者rt-PA静脉溶栓后7d的出血转化及90d的功能结局情况,判断CMB是否对小动脉闭塞型急性缺血性卒中rt-PA静脉溶栓产生影响。结果:共收集到CMB阳性组患者36例(40%),CMB阴性组患者53例(59%)。通过对患者溶栓后功能预后的单因素分析发现,CMB阳性组(χ^(2)=7.456,P=0.024),CMB高负荷组(χ^(2)=13.95,P=0.000)的患者有更高的功能结局不利和(或)不良。通过多因素有序Logistic回归分析发现,CMB阴性(OR=0.307,95%CI—2.340——0.021)以及既往无高血压病史(OR=0.193,95%CI,—3.054——0.234)较C M B阳性的及合并高血压病史的患者rt-PA静脉溶栓后功能预后不利和(或)不良的发生率更低。比较发现CMB阳性组与阴性组之间7d出血转化差异无显著意义。结论:①CMB的存在及CMB的负荷程度不增加小动脉闭塞型卒中患者rt-PA静脉溶栓后出血转化的风险;但可增加rt-PA静脉溶栓后功能结局不利和(或)不良的发生率;②虽然CMB的存在可导致小动脉闭塞型卒中患者静脉溶栓后更高的90 d功能结局不利和(或)不良率,但总体比例是比较低的,故对小动脉闭塞型卒中患者,在溶栓前行多模式的颅脑MRI检查可能是不必要的,因为这可能导致DNT时间的延长,从而降低静脉溶栓的效果。展开更多
Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Comp...Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.展开更多
文摘目的:探讨脑微出血(CMB)对小动脉闭塞型急性缺血性卒中患者rt-PA静脉溶栓后出血转化及预后的影响。方法:选择2018年1月至2020年2月在贵州医科大学附属医院神经内科进行rt-PA溶栓的小动脉闭塞型急性缺血性卒中患者作为研究对象,按有无CMB分为CMB阳性组与CMB阴性组,其中CMB阳性组根据CMB的个数分为低负荷组(1〜4个)和高负荷组CMB(≥5个)。所有患者均在时间窗内进行rt-PA静脉溶栓,并记录患者的一般临床资料。根据患者rt-PA静脉溶栓后7d的出血转化及90d的功能结局情况,判断CMB是否对小动脉闭塞型急性缺血性卒中rt-PA静脉溶栓产生影响。结果:共收集到CMB阳性组患者36例(40%),CMB阴性组患者53例(59%)。通过对患者溶栓后功能预后的单因素分析发现,CMB阳性组(χ^(2)=7.456,P=0.024),CMB高负荷组(χ^(2)=13.95,P=0.000)的患者有更高的功能结局不利和(或)不良。通过多因素有序Logistic回归分析发现,CMB阴性(OR=0.307,95%CI—2.340——0.021)以及既往无高血压病史(OR=0.193,95%CI,—3.054——0.234)较C M B阳性的及合并高血压病史的患者rt-PA静脉溶栓后功能预后不利和(或)不良的发生率更低。比较发现CMB阳性组与阴性组之间7d出血转化差异无显著意义。结论:①CMB的存在及CMB的负荷程度不增加小动脉闭塞型卒中患者rt-PA静脉溶栓后出血转化的风险;但可增加rt-PA静脉溶栓后功能结局不利和(或)不良的发生率;②虽然CMB的存在可导致小动脉闭塞型卒中患者静脉溶栓后更高的90 d功能结局不利和(或)不良率,但总体比例是比较低的,故对小动脉闭塞型卒中患者,在溶栓前行多模式的颅脑MRI检查可能是不必要的,因为这可能导致DNT时间的延长,从而降低静脉溶栓的效果。
文摘Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.
