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目的探讨磁共振成像(magnetic resonance imaging,MRI)动脉自旋标记技术(arterial spin label,ASL)指导缺血性卒中静脉溶栓治疗的有效性和安全性,探索新的、高效的指导急性缺血性卒中静脉溶栓的技术。方法入选发病至就诊时间大于3 h,在MRI-ASL指导下进行重组组织型纤溶酶原激活物(recombinant tissue plasminogen activator,rt-PA)静脉溶栓的急性缺血性卒中患者,同时选取在MRI灌注加权像(perfusion-weighted imaging,PWI)指导下进行rt-PA静脉溶栓的急性缺血性卒中患者为对照组。比较两组患者的基线资料、既往病史、入院至溶栓时间、影像学检查至溶栓时间、发病90 d的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、预后良好[改良Rankin量表(modified Rankin Scale,m RS)0~1分]率及出血转化发生率等。结果 ASL组和PWI组相比,基线数据无显著差异;出血转化率也无显著差异。ASL组影像学检查至溶栓时间短于PWI组([65±15)min vs(73±11)min,P=0.031]。结论 ASL较PWI技术指导急性缺血性卒中静脉溶栓可以减少延误时间,其安全性和有效性无差异。
Objective To investigate the effectiveness and safety of arterial spin label (ASL) guided by magnetic resonance imaging (MRI) in guiding the treatment of thrombolytic therapy of ischemic stroke and to explore new and effective methods to guide acute ischemia Venous thrombolysis in patients with stroke. Methods Acute ischemic stroke patients who were treated at the time of onset of treatment more than 3 h underwent intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) under the guidance of MRI-ASL. At the same time, Patients with acute ischemic stroke undergoing intravenous rt-PA thrombolysis under MRI-guided perfusion-weighted imaging (PWI) served as controls. Baseline data, past medical history, admission to thrombolysis time, imaging to thrombolysis time, 90-day National Institutes of Health Stroke Scale (NIHSS) score, and prognosis were compared between the two groups Good [0 to 1 score] for modified Rankin Scale (mRSR) and the incidence of hemorrhagic transformation. Results There was no significant difference in baseline data between the ASL group and the PWI group; there was no significant difference in hemorrhagic transformation rate. The time from imaging examination to thrombolysis in the ASL group was shorter than that in the PWI group (65 ± 15 min vs 73 ± 11 min, P = 0.031). Conclusion Compared with PWI, ASL can guide the treatment of acute ischemic stroke intravenous thrombolysis can reduce the delay time, the safety and effectiveness of no difference.