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目的探讨多模式CT指导下rt-PA静脉溶栓治疗急性脑梗死的疗效与安全性。方法选择16例符合美国国立神经疾病与卒中研究院溶栓试验(NINDS)标准的急性脑梗死患者行多模式CT检查,对符合溶栓标准的8例患者给予重组组织型纤溶酶原激活物(rt-PA)0.9mg/kg溶栓治疗,比较治疗前和治疗后24h、7d、30d的美国卫生研究院卒中量表(NIHSS)评分及生活质量评分(Barthel)指数。结果治疗前NIHSS评分为(12.8±5.33),治疗后24h、7d、30d的NIHSS评分分别为(10.01±6.69)(6.77±3.56)、(4.12±3.09),治疗前和治疗后7d、30d比较差异有统计学意义(P<0.05);治疗前生活质量评分(Barthel)指数为(20.63±8.67),治疗后24h、7d、30dBarthel指数分别为(22.77±8.96)、(45.78±23.89)、(59.45±31.03),治疗前和治疗后7d、30d比较差异有统计学意义(P<0.05)。1例因再梗塞死亡。结论多模式CT指导下的急性脑梗死早期rt-PA静脉溶栓治疗是有效和安全的,有助于减少症状性颅内出血风险,使更多的患者从溶栓治疗中获益。
Objective To investigate the efficacy and safety of intravenous thrombolysis with rt-PA guided by multimodal CT in the treatment of acute cerebral infarction. Methods Sixteen patients with acute cerebral infarction who met the criteria of thrombolysis test (NINDS) from National Institute of Neurological Disorders and Stroke, underwent multi-modal CT examination. Eight patients who met thrombolysis criteria were given recombinant tissue plasminogen activator (rt-PA) 0.9mg / kg thrombolytic therapy was used to compare the NIHSS score and Barthel index before treatment and 24h, 7d, 30d after treatment. Results The NIHSS score before treatment was (12.8 ± 5.33), NIHSS scores at 24, 7 and 30 days after treatment were (10.01 ± 6.69) and (6.77 ± 3.56) and (4.12 ± 3.09) respectively, before and after treatment The Barthel index before treatment was (20.63 ± 8.67), and the 30 dBarthel index at 24 and 7 days after treatment were (22.77 ± 8.96) and (45.78 ± 23.89), respectively (P <0.05) 59.45 ± 31.03). There was significant difference between pre-treatment and post-treatment 7d, 30d (P <0.05). One patient died of reinfarction. Conclusion The multi-modal CT-guided early thrombolysis of rt-PA in acute cerebral infarction is effective and safe, which can help reduce the risk of symptomatic intracranial hemorrhage and benefit more patients from thrombolytic therapy.