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目的分析以磁共振成像DWI-FLAIR不匹配指导觉醒型卒中患者静脉溶栓治疗安全性及预后。方法选择华北理工大学附属医院2012年9月—2015年10月住院的缺血性脑卒中患者247例。根据发病时间是否明确分为觉醒型卒中组(觉醒组)和缺血性卒中组(明确发病组),其中觉醒组64例,明确发病组183例。二组患者入院后均行16层颅脑CT检查以排除脑出血。对于发病时间不确定的患者需另行MRI+DWI检查。对二组中符合预先设定的临床入选标准,并且无溶栓禁忌证的患者给予重组组织型纤溶酶原激活物(rt-PA)溶栓治疗。溶栓治疗的安全性通过溶栓后脑出血来评价;预后采用90d mRS评分和90d死亡率来评价。采用t检验和χ2检验分析觉醒型卒中患者溶栓治疗的安全性和预后。结果二组患者在性别、年龄、入院时NIHSS评分及发病危险因素方面差异均无统计学意义(P均>0.05)。二组患者溶栓治疗后症状性颅内出血(sICH)发生率分别为3.12%和2.79%,差异无统计学意义;轻微颅内出血发生率分别为6.25%和9.50%,差异无统计学意义。二组患者90d mRS评分0~1分分别为35.94%和37.99%(χ2=0.085,P=0.771)、90d mRS评分0~2分分别为53.12%和63.13%(χ2=1.974,P=0.160)差异均无统计学意义。二组患者90d病死率分别为3.12%和1.68%,差异无统计学意义(χ2=0.035,P>0.05)。结论根据患者发病时间来作为溶栓治疗的时间窗,可能会有相当一部分觉醒型卒中患者被排除于溶栓治疗之外。以DWI-FLAIR指导下的静脉溶栓治疗是安全、有效的,并不增加脑出血的风险,可以改善患者的预后;对于觉醒型卒中以DWI-FLAIR不匹配进行筛查,仍有一部分患者可通过溶栓治疗获益。
Objective To analyze the safety and prognosis of intravenous thrombolytic therapy guided by DWI-FLAIR mismatch in patients with arousal stroke by magnetic resonance imaging. Methods 247 patients with ischemic stroke admitted to the Affiliated Hospital of North China University of Technology from September 2012 to October 2015 were enrolled. According to whether the onset time is clearly divided into arousal stroke group (awakening group) and ischemic stroke group (clear onset group), including awake group of 64 cases, 183 cases of clear onset group. Two groups of patients were admitted to the hospital after 16 layers of brain CT examination to rule out cerebral hemorrhage. For patients with uncertain onset time need additional MRI + DWI examination. Patients in both groups who met pre-defined clinical inclusion criteria and who had no thrombolytic contraindications were given recombinant tissue plasminogen activator (rt-PA) for thrombolysis. The safety of thrombolytic therapy was evaluated by cerebral hemorrhage after thrombolysis; the prognosis was assessed by 90-day mRS score and 90-day mortality. The safety and prognosis of thrombolytic therapy in patients with arousal stroke were analyzed by t test and χ2 test. Results There was no significant difference in NIHSS score, risk factors and incidence of NIHSS between the two groups (P> 0.05). The incidences of symptomatic intracranial hemorrhage (sICH) in the two groups were 3.12% and 2.79%, respectively, with no significant difference. The incidences of mild intracranial hemorrhage were 6.25% and 9.50% respectively, with no significant difference. The 90-day mRS scores of 0 to 1 were 35.94% and 37.99% in the two groups (χ2 = 0.085, P = 0.771, P <0.05) The difference was not statistically significant. The 90-day mortality of the two groups were 3.12% and 1.68% respectively, with no significant difference (χ2 = 0.035, P> 0.05). Conclusion According to the time of onset of patients as a thrombolytic time window, a considerable number of patients with arousals may be excluded from thrombolytic therapy. Intravenous thrombolysis under the guidance of DWI-FLAIR is safe and effective, does not increase the risk of cerebral hemorrhage, can improve the prognosis of patients; screening for arousal stroke with DWI-FLAIR mismatch, there are still some patients Benefit from thrombolytic therapy.