内科

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。

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.