中国卒中杂志Issue(2)：109-114,6.DOI:10.3969/j.issn.1673-5765.2016.02.004
多模式CT指导下的扩大时间窗溶栓治疗病例分析
Case Analysis of Intravenous Thrombolysis in the Expanded Time Window under the Guidance of Multimode CT
摘要
Abstract
Objective To evaluate the effectiveness and safety of the intravenous thrombolysis in acute stroke patients by recombinant tissue plasminogen activator (rtPA) within 4.5~9 hours under the guidance of multimode computed tomography (CT). Methods A total of 6 patients who were clinically diagnosed as acute ischemic stroke and reached hospital within 4.5~9 hours were recruited by Dept. of Neurology of Nanjing Drum Tower Hospital between 2008 and 2009. After the examination of multimode CT, the qualiifed patients were given intravenous thrombolysis treatment with rtPA (0.9mg/kg). The National Institute Health Stroke Scale (NIHSS) was assessed at baseline and 2h, 24h, 7d after the treatment. modiifed Rankin Scale (mRS) and the Barthel Index (BI) at 7d and 90d after the intravenous thrombolysis were calculated to evaluate neurological function and daily life capability respectively. Multimode CT was performed again at 24h after the treatment to calculate the recanalization of vessels. Thrombolysis in Cerebral Ischemia Scale (TICI) score was applied to assess the severity of vessel stenosis. Results Among 6 patients enrolled in the study, one patient developed cerebral hemorrhage. TICI grade score of 6 patients at 24 h after thrombolysis was signiifcantly increased compared with the baseline score (2.0+0.71vs 1.0+0.71,P=0.03). Except for the patients with cerebral hemorrhage, the NIHSS score of pre-treatment and 7 days post-treatment of the rest patients were 12.2±3.27 and 9.4±3.78 respectively, which achieved signiifcant statistic difference (P=0.04). In terms of the daily life capability, compared to 7 days after thrombolysis, BI score at 90 d was slightly improved and there was no signiifcant difference (62.5±27.23vs 47.5±27.84,P=0.13). The mRS scoce at 90 d was better than that at 7 d, but there was no signiifcant difference (4±0.82vs 3±0.82,P=0.09). Conclusion The intravenous thrombolysis treatment of acute ischemic stroke in the expanded time window under the guidance of multimode CT can promote the vessel recanalization, neural function recovery as well as daily activity restoration.关键词
缺血性卒中/多模式CT/静脉溶栓/扩大时间窗Key words
Ischemic stroke/Multimode computed tomography (CT)/Intravenous thrombolysis/Expanded time window引用本文复制引用
张梅娟,劳加敏,王中原,夏名浒,徐运..多模式CT指导下的扩大时间窗溶栓治疗病例分析[J].中国卒中杂志,2016,(2):109-114,6.基金项目
国家自然基金（81571135，81200879，81230026，81171085）江苏省科技厅医学重点项目（BL2012013）江苏省医学创新团队及领军人才 （）
