静脉溶栓治疗卒中预警综合征16例分析

doi:10.3969/j.issn.1672-6731.2020.05.011

摘要/Abstract

摘要：

目的总结卒中预警综合征的临床和影像学特点，探讨静脉溶栓治疗卒中预警综合征的有效性和安全性。方法纳入2017年1月至2019年7月共16例卒中预警综合征患者，均予rt-PA静脉溶栓治疗以及抗血小板、调脂等治疗，采用美国国立卫生研究院卒中量表（NIHSS）评价神经功能，改良Rankin量表（mRS）评价预后，观察有无出血性转化和脑卒中复发。结果 16例患者既往有高血压13例次、高同型半胱氨酸血症12例次、高脂血症9例次，吸烟10例次。临床主要表现为单纯运动障碍（7例）和运动感觉障碍（9例）；发作次数3~9次，持续时间3~240 min。DWI显示13例（81.25%）可见急性新发梗死灶；CTA或MRA显示14例可见头颈部动脉粥样硬化斑块。溶栓后13例病情完全缓解（5/16）、明显缓解（1/16）或部分缓解（7/16），3例不同程度加重。溶栓后24 h和出院时NIHSS评分低于入院时和病程中最大值（均P=0.000），而入院时与病程中最大值（P=0.433）、溶栓后24 h与出院时（P=0.054）NIHSS评分差异无统计学意义。14例预后良好（mRS评分<2分）。无一例发生出血性转化和远期复发。结论对于时间窗内的卒中预警综合征患者，rt-PA静脉溶栓可能是一种有效的治疗方法。

关键词: 卒中预警综合征(非 MeSH 词), 血栓溶解疗法, 组织型纤溶酶原激活物

Abstract:

Objective To evaluate the clinical characteristics, imaging manifestations and the efficacy and safety of intravenous thrombolytic for patients with stroke warning syndrome (SWS). Methods Sixteen patients with SWS from January 2017 to July 2019 were reviewed. The rt-PA intravenous thrombolysis and antiplatelet, lipid adjusting were treated. National Institutes of Health Stroke Scale (NIHSS) was performed to evaluate neurological function and modified Rankin Scale (mRS) was performed to evaluate prognosis, and to observe the presence of hemorrhagic transformation (HT) and recurrence of stroke. Results The most frequent preexisting risk factors were hypertension (13 cases), hyperhomocysteinemia (12 cases), dyslipidemia (9 cases) and smoking history (10 cases). All patients presented with pure motor syndrome (n=7) or sensory motor syndrome (n=9). All patients had 3-9 clinical fluctuations before treatment and the duration of symptoms ranged from 3-240 min. In 13 of 16 SWS patients, DWI showed acute cerebral infarctions. CTA or MRA showed atherosclerotic plaques in 14 cases. Thirteen patients experienced favorable recovery, complete remission (5/16), significant remission (1/16) and partial remission (7/16), respectively. Fourteen patients reached favorable outcome (mRS <2 at 3 months). NIHSS score at 24 h after intravenous thrombolytic and at discharge were lower than that on admission and the maximum value in the course of disease (P=0.000, for all), while NIHSS score on admission and the maximum value in the course of disease (P=0.433), and at 24 h after intravenous thrombolytic and discarge time (P=0.054), were no significant statistical difference. Conclusions Intravenous thrombolysis may be a potentially effective therapy for patients with SWS within the therapeutic time window.

Key words: Stroke warning syndrome (not in MeSH), Thrombolytic therapy, Tissue plasminogen activator

彭静玉. 静脉溶栓治疗卒中预警综合征16例分析[J]. 中国现代神经疾病杂志, 2020, 20(5): 434-440.

PENG Jing-yu. Intravenous thrombolytic for 16 patients with stroke warning syndrome[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 434-440.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I5/434

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