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目的探讨CT灌注成像技术(CTP)指导下急性脑梗死溶栓治疗的效果。方法发病6 h内的急性脑梗死患者200例,溶栓前均行CTP检查,根据CTP检查结果,分为存在半暗带组和不存在半暗带组,用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓,观察2组患者溶栓前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)、改良Rankin量表(mRS)评分以及出血性转化等事件,评估2组患者治疗有效率、良好预后率。结果与不存在半暗带组(6.67±3.46)比较,存在半暗带组患者溶栓7 d后NIHSS评分明显降低(4.76±2.04),4周时降低最明显(3.68±1.93)。存在半暗带组4周时有效率(60.3%)、3个月时良好预后率(71.7%)均明显优于不存在半暗带组(34.7%,56.8%)。结论 CTP指导下rt-PA静脉溶栓治疗安全有效,可根据半暗带扩大溶栓治疗窗,并且出血转化率低。
Objective To investigate the effect of thrombolysis in acute cerebral infarction under the guidance of CT perfusion imaging (CTP). Methods 200 patients with acute cerebral infarction within 6 hours after onset were examined by CTP before thrombolysis. According to the results of CTP examination, they were divided into penumbra group and penumbra group and were treated with recombinant tissue plasminogen activator (Rt-PA) were given intravenously to observe the NIH Stroke Scale (NIHSS) score, Barthel Index (BI), modified Rankin Scale (mRS) score and hemorrhagic transformation before and after thrombolysis , To evaluate the two groups of patients with effective treatment, good prognosis. Results Compared with the penumbral group (6.67 ± 3.46), the NIHSS score in the penumbra group decreased significantly (4.76 ± 2.04) after 7 days of thrombolysis and was the most significant (3.68 ± 1.93) at 4 weeks. The effective rate was 60.4% in the penumbral group at 4 weeks and that in 3 months was significantly higher than 71.7% in the penumbra group (34.7%, 56.8%). Conclusion CTP-guided rt-PA intravenous thrombolysis is safe and effective, according to the penumbral expansion of thrombolytic therapeutic window, and the conversion rate of bleeding is low.