[1]张金凤,李光,苏果,等.不明发病时间急性脑梗死患者的CTPI溶栓抉择及疗效评价▲[J].内科,2018,13(04):547-550.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2018.04.03]
 ZHANG Jinfeng,LI Guang,SU Guo,et al.CTPI examination of patients with acute cerebral infarction with unknown onset time to determine whether thrombolytic therapy and evaluation of its efficacy[J].Internal Medicine of China,2018,13(04):547-550.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2018.04.03]
点击复制

不明发病时间急性脑梗死患者的CTPI溶栓抉择及疗效评价▲()
分享到:

《内科》[ISSN:1006-6977/CN:61-1281/TN]

卷:
13卷
期数:
2018年04
页码:
547-550
栏目:
论著
出版日期:
2018-08-13

文章信息/Info

Title:
CTPI examination of patients with acute cerebral infarction with unknown onset time to determine whether thrombolytic therapy and evaluation of its efficacy
文章编号:
1673-7768(2018)04-0547-04
作者:
张金凤李光苏果陈飞
驻马店市第二中医院,河南省驻马店市463000
Author(s):
ZHANG Jinfeng LI Guang SU Guo CHEN Fei
Second Chinese medicine hospital of Zhumadian City, Zhumadian, Henan 463000, China
关键词:
急性脑梗死治疗CT灌注成像缺血半暗带阿替普酶
Keywords:
Acute cerebral infarction CT perfusion imaging Ischemic penumbra Alteplase
分类号:
R 743
DOI:
DOI:10.16121/j.cnki.cn45-1347/r.2018.04.03
文献标志码:
A
摘要:
目的探讨通过CT灌注成像(CTPI)影像学确定脑组织缺血半暗带,对急性脑梗死患者进行阿替普酶(rt-PA)静脉溶栓治疗的效果。方法选取发病时间不明确、在我院经CTPI影像学检查证实存在缺血半暗带的急性脑梗死患者60例,按照随机数字表法分为观察组和对照组各30例。对照组患者给予常规基础治疗;观察组患者在基础治疗的基础上给予阿替普酶(rt-PA)静脉溶栓治疗1次。治疗14 d后,进行CTPI检查,检测比较两组患者梗死区域的脑血流量(CBF) 、脑血容量(CBV)和血流平均通过时间(MTT);检测比较两组患者的血浆同型半胱氨酸(Hcy)、血管性假血友病因子(VWF)和α颗粒膜蛋白-140(GMP-140)血栓相关因子水平;采用美国国立卫生研究院卒中量表(NIHSS)评定比较两组患者的神经功能,采用Barthel指数评定比较两组患者的日常生活能力。结果治疗14 d后,观察组患者脑梗死核心区、缺血半暗带区的CBV、CBF显著增加且大于对照组,MTT显著减少且小于对照组,差异具有统计学意义(P<0.05);两组患者的Hcy、VWF和GMP-140水平均明显降低,观察组患者的水平显著低于对照组,差异有统计学意义(P<0.05);两组患者的NIHSS积分均明显降低、BI积分均明显升高,观察组患者的NIHSS积分显著低于对照组、BI积分显著高于对照组,差异有统计学意义(P<0.05)。两组患者均未出现血、尿、大便常规及肝肾功能异常,无颅内出血发生。结论通过CT灌注成像影像学确定脑组织缺血半暗带,对急性脑梗死患者进行阿替普酶(rt-PA)静脉溶栓治疗,能够明显改善缺血半暗带区脑组织灌注,降低血栓相关因子水平,改善神经功能缺损,治疗安全性高。
Abstract:
ObjectiveTo investigate the ischemic penumbra of brain tissue by CT perfusion imaging (CTPI) examination. The effect of alteplase (rt-PA) intravenous thrombolysis on patients with acute cerebral infarction. Methods60 patients with unclear onset time acute cerebral infarction of ischemic penumbra by CTPI examination imaging in our hospital were selected. According to the random number table method, the investigators were divided into observation group and control group, 30 cases each. Patients in the control group were given routine basic therapy, patients in the observation group were treated with alteplase (rt-PA) intravenous thrombolytic therapy once on the basis of basic therapy. After 14 days of treatment, the cerebral blood flow (CBF), cerebral blood volume (CBV) and mean blood flow time (MTT) of the infarcted area by CTPI examination of the two groups were compared. Plasma levels of homocysteine (HCY), von Willebrand factor (VWF) and a granule membrane protein-140 (GMP-140) thrombo-related factors were compared between the two groups. The National Institutes of Health Stroke Scale (NIHSS) was used to compare the neurological function of the two groups, and the Barthel index was used to compare the daily living ability of the two groups. ResultsAfter 14 days of treatment, the CBV and CBF of the cerebral infarction core area and the ischemic penumbra area of the observation group increased significantly and were bigger than the control group, and the MTT was significantly decreased and less than the control group, the difference was statistically significant (P<0.05). The levels of Hcy, VWF and GMP-140 in the two groups were significantly lower than those in the control group, and the difference was statistically significant (P<0.05). The NIHSS scores of both groups were significantly reduced and the BI scores were significantly increased. The NIHSS scores of the observation group were significantly lower than those of the control group, and the BI scores were significantly higher than the control group (P<0.05). There were no blood, urine, stool routine and liver and kidney dysfunction in both groups, and no intracranial hemorrhage occurred. ConclusionThe ischemic penumbra of brain tissue was determined by CT perfusion imaging (CTPI) imaging. The treatment of alteplase (rt-PA) intravenous thrombolysis in patients with acute cerebral infarction can significantly improve the brain tissue in the ischemic penumbra Perfusion, reduce the level of thrombotic factors, improve neurological deficits, and safety.

相似文献/References:

[1]方志荣,房林燕,段冬云,等.急性脑梗死患者血清超敏C反应蛋白、纤维蛋白原和尿酸与颈动脉粥样硬化的关系[J].内科,2014,(05):523.
 FANG Zhi rong,FANG Lin yan,DUAN Dong yun,et al.Relationship of high sensitivity Creactive protein, fibrinogen, uric acid and carotid artery arteriosclerosis in patients with acute cerebral infarction[J].Internal Medicine of China,2014,(04):523.
[2]华占楼,孙继妹,谢金春,等.早期小剂量地塞米松对急性胰腺炎治疗效果的影响[J].内科,2014,(05):531.
 HUA Zhan lou,SUN Ji mei,XIE Jin chun.Treatment effect of small dosage of dexamethsone in patients with acute pancreatitis in the early time[J].Internal Medicine of China,2014,(04):531.
[3]刘昌灵,何明璋.常规疗法联用盐酸帕罗西汀治疗功能性消化不良的疗效观察[J].内科,2014,(05):534.
 LIU Chang ling,HE Ming zhang.Therapeutic effect of the conventional therapy plus paroxetine on the functional dyspepsia[J].Internal Medicine of China,2014,(04):534.
[4]洪长发.阿奇霉素联合头孢曲松治疗社区获得性肺炎疗效观察[J].内科,2014,(05):546.
[5]骆振波.炎琥宁治疗流行性腮腺炎66例临床疗效观察[J].内科,2014,(05):548.
[6]张喜民,刘文智,豆永强,等.胺碘酮治疗心力衰竭合并室性心律失常63例临床疗效观察[J].内科,2014,(05):552.
[7]莫小琼,蓝惠珍,莫如珍,等.血液透析滤过治疗尿毒症顽固性高血压的疗效观察与护理[J].内科,2014,(05):588.
[8]陶林.曲美他嗪治疗缺血性心肌病心力衰竭30例疗效观察[J].内科,2015,(01):11.[doi:03DOI:10.16121/j.cnki.cn45-1347/r.2015.01.04]
 [J].Internal Medicine of China,2015,(04):11.[doi:03DOI:10.16121/j.cnki.cn45-1347/r.2015.01.04]
[9]胡文标.曲美他嗪治疗缺血性心肌病心力衰竭疗效观察[J].内科,2015,(01):13.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2015.01.05]
 [J].Internal Medicine of China,2015,(04):13.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2015.01.05]
[10]王普.厄贝沙坦治疗轻、中度高血压患者24例的临床疗效观察[J].内科,2015,(01):17.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2015.01.07]
 [J].Internal Medicine of China,2015,(04):17.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2015.01.07]
[11]农媛 樊金莲 肖海.高压氧治疗时机对急性脑梗死疗效影响的临床研究[J].内科,2013,(02):109.
 NONG Yuan,FAN Jin-lian,XIAO Hai.Clinical study of the effect of hyperbaric oxygen therapy started at different time on patients with acute cerebral infarction[J].Internal Medicine of China,2013,(04):109.
[12]陈莉 邹东华 陈娅 曹小丽 秦超 莫雪安.通心络胶囊治疗急性脑梗死的疗效评价[J].内科,2013,(04):345.
 CHEN Li,ZOU Dong-hua,CHEN Ya,et al.Therapeutic effect of tongxinluo capsule on acute cerebral infarction[J].Internal Medicine of China,2013,(04):345.
[13]刘德祥.盐酸法舒地尔治疗急性脑梗死的疗效及对hs-CRP的影响[J].内科,2012,(06):591.
 [J].Internal Medicine of China,2012,(04):591.
[14]古联,谢娟娟,陈炜.依达拉奉联合东菱迪芙治疗急性脑梗死疗效观察▲[J].内科,2011,(06):532.
 GU Lian,XIE Juan-juan,CHEN Wei.Efficacy observation of Edaravone combined with Batroxobin in the treatment of acute cerebral infarction[J].Internal Medicine of China,2011,(04):532.
[15]符达峰,农维昌,王英,等.丁苯酞治疗急性脑梗死患者临床疗效观察[J].内科,2016,(01):83.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2016.01.30]
 [J].Internal Medicine of China,2016,(04):83.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2016.01.30]
[16]梁土金,曾祥富,林武壮.醒脑静注射液联合纤溶酶治疗急性脑梗死患者临床疗效分析[J].内科,2016,(06):905.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2016.06.32]
 [J].Internal Medicine of China,2016,(04):905.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2016.06.32]
[17]曾玮.急性脑梗死后继发癫痫患者的视频脑电图特点分析[J].内科,2016,(06):927.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2016.06.40]
 [J].Internal Medicine of China,2016,(04):927.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2016.06.40]
[18]宋卫红.参芎葡萄糖注射液联合脑蛋白水解物治疗对急性脑梗死患者神经功能及血液流变学的影响[J].内科,2017,12(03):370.[doi:DOI:10.16121/j.cnki.cn451347/r.2017.03.23]
 [J].Internal Medicine of China,2017,12(04):370.[doi:DOI:10.16121/j.cnki.cn451347/r.2017.03.23]
[19]赵旭华.普罗布考联合瑞舒伐他汀治疗急性脑梗死的疗效及对脂质代谢的影响[J].内科,2018,13(02):221.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2018.02.23]
 [J].Internal Medicine of China,2018,13(04):221.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2018.02.23]
[20]闫贵国,郭淑红,石晓娟,等.养血清脑颗粒联合阿替普酶治疗急性脑梗死的疗效及对患者炎症因子和凝血功能的影响[J].内科,2018,13(04):574.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2018.04.11]
 YAN Guiguo,GUO Shuhong,SHI Xiaojuan,et al.Efficacy of Yangxue Qing Nao granule combined with alteplase in treating acute cerebral infarction and its effects on inflammatory factors and coagulation function[J].Internal Medicine of China,2018,13(04):574.[doi:DOI:10.16121/j.cnki.cn45-1347/r.2018.04.11]

备注/Memo

备注/Memo:
▲基金项目:河南省科技攻关计划项目(162102310115)
更新日期/Last Update: 2018-08-14