摘要： 目的 探讨阿替普酶规范剂量静脉溶栓治疗急性缺血性卒中的效果，以及在治疗“时间窗”内获得溶栓治疗对脑组织缺血-再灌注损伤及患者预后的影响。方法 回顾分析86例阿替普酶静脉溶栓治疗急性缺血性卒中患者的临床资料，根据多模态MRI 评价溶栓后24h 及3 个月时疗效，美国国立卫生研究院卒中量表（NHISS ）和改良 Rankin量表（mRS ）评价神经功能改善程度和预后 。结果 86例患者中前循环缺血56例、后循环缺血30例。溶栓治疗后24h ，神经功能恢复良好者 62例占72.09%、不良者24例占27.91%，治疗前后 NHISS 评分差异有统计学意义（P = 0.023）；42例行多模态MRI 检查者阻塞血管完全再通18例占42.86%、部分再通6 例占14.28%、闭塞18例占42.86%，与溶栓前相比差异有统计学意义（P = 0.073）。3 个月随访时，神经功能预后良好者78例占90.70%、不良者8 例占9.30% ，与溶栓相比差异有统计学意义（P = 0.008）。结论 阿替普酶静脉溶栓治疗后脑血管再通和脑组织再灌注是判断临床疗效的可靠指标。

关键词: 急性病, 脑缺血, 卒中, 组织型纤溶酶原激活物, 血栓溶解疗法, 再灌注

Abstract: Objective  The incidence of stroke in China has been growing year by year and has become the first cause of death exceeding cancer and heart disease. However, non-standard thrombolytic drug dose and therapeutic time window have seriously affected the treating effect of acute ischemic stroke. This study aims to explore the effect of intravenous alteplase with standard dose and reperfusion injury of ischemic brain tissue and prognosis of patients receiving thrombolytic therapy within therapeutic time window. Methods  Clinical data of 86 patients with acute ischemic stroke receiving thrombolytic therapy with alteplase were retrospectively analyzed. Efficacy at 24 h and 3 months after thrombolysis was evaluated according to the multi-modal MRI, and the U.S. National Institutes of Health Stroke Scale (NHISS) and modified Rankin Scale (mRS) were used to identify the extent of neurological function improvement and prognosis of patients. Results  Among 86 patients, 56 cases were anterior circulation ischemia, and 30 cases were posterior circulation ischemia. At 24 h after thrombolysis, 62 cases with favorable neurological function outcome accounted for 72.09%, and 24 cases with poor outcome accounted for 27.91%. The NHISS scores before and after thrombolysis were statistically different ( P = 0.023). Based on multi-modal MRI of 42 cases at 24 h after thrombolysis, there were 18 cases with complete vascular recanalization (42.86%), 6 cases with partial recanalization (14.28%) and 18 cases with occlusion (42.86%). The difference before and after thrombolytic thearpy was statistically significant (P = 0.073). In the follow-up of 3 months, 78 patients with favorable function outcome accounted for 90.70%, and 8 cases with poor outcome accounted for 9.30%, which were significantly different from that before thrombolysis ( P = 0.008). Conclusion  Cerebral vascular recanalization and reperfusion of brain tissue are reliable indicators ofclinical efficacy for intravenous thrombolysis with alteplase.

Key words: Acute diseases, Brain ischemia, Stroke, Tissue plasminogen activator, Thrombolytic therapy, Reperfusion