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多模MRI在急性缺血 性脑卒中患者诊治 中的应用

作者:尹刘杰1 赵松耀1 王洪科1 李佳佳1 李润涛2

所属单位:1.河南省郑州市中心医院神经内五 科 (河南 郑州 450000) 2.河南省郑州市中心医院放射科 (河南 郑州 450000)

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摘要

目的 探究多模式磁共振成像 (MRI)在急性缺血性脑卒中(AIS)诊治中的 应用效果。方法 回顾性分析我院发病时 间为4.5h-9h的210例AIS患者临床资料。 经多模式MRI中弥散加权成像(DWI)及液体 衰减反转恢复序列(FLAIR)不匹配筛选超 急性期AIS患者,并根据其是否接受溶栓 治疗分为溶栓治疗组(观察组)及非溶栓治 疗组(对照组),比较两组治疗前一般资料 及治疗后临床疗效[治疗7d后美国国立卫 生研究院卒中量表(NIHSS)、日常生活能 力评定量表(BI)]、预后情况[治疗90d后 BI、改良Rankin评分(mRS)]差异。结果 210例AIS患者中102例(48.57%)DWI/FLAIR 不匹配,判定为超急性期AIS,其中接受 溶栓治疗的有64例(62.75%,即观察组), 38例(37.25%,即对照组)不愿接受溶栓治 疗。两组患者一般资料比较,差异无统计 学意义(P>0.05)。观察组治疗7d后NIHSS 评分、治疗30d后mRS评分均低于对照组(P <0.05),而治疗7d及治疗90d后BI评分均 高于对照组(P<0.05)。结论 多模式MRI 能辅助评估超急性期AIS患者,筛选出溶 栓治疗适应病例,有助于提高AIS患者临 床疗效、改善预后。

Objective To explore the effects of multimodal magnetic resonance imaging (MRI) in the diagnosis and treatment of acute ischemic stroke (AIS). Methods The clinical data of 210 patients with AIS who had a onset time from 4.5h to 9h in our hospital were analyzed retrospectively. Multimodal MRI diffusion-weighted imaging (DWI) and fluidattenuated inversion-recovery sequence (FLAIR) mismatching were used to screen patients with AIS in hyperacute phase, and the patients were divided into thrombolytic therapy group (observation group) and non-thrombolytic group (control group) according to whether they received thrombolytic therapy or not. The general data before treatment, clinical efficacy after treatment [National Institute of Health Stroke Scale (NIHSS), Daily Living Ability Rating Scale (BI)] and prognosis [BI after 90d of treatment, modified Rankin score (mRS)] were compared between the two group. Results Of the 210 AIS patients, 102 cases (48.57%) were with DWI/FLAIR mismatching and were judged to be AIS in hyperacute phase. Among them, 64 cases (62.75%, observation group) received thrombolytic therapy and 38 cases (37.25%, control group) were reluctant to receive thrombolytic therapy. There were no significant differences in the general data between the two groups (P>0.05). The NIHSS score after 7d of treatment and the mRS score after 30d of treatment in observation group were lower than those in control group (P<0.05), but the BI scores after 7d of treatment and after 90d of treatment were higher than those in control group (P<0.05). Conclusion Multimodal MRI can assist to evaluate patients with AIS in hyperacute phase, and screen the adaptation cases for thrombolytic therapy, and it can improve the clinical efficacy and promote the prognosis of AIS patients.

【关键词】急性缺血性脑卒中;多模式磁 共振成像;DWI;FLAIR;溶栓

【中图分类号】R743;R445

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.03.016

前言

急性缺血性脑卒中(AIS)为临床常见急危重症之一,尽早开通阻塞 血管、挽救缺血半暗带为其主要治疗方向[1],静脉溶栓为治疗AIS的有 效手段,但临床溶栓血管再通率较低,多与治疗时间窗有关。目前, 静脉溶栓时间窗为6h内,部分患者受溶栓治疗时间窗的限制,无法行 溶栓治疗;但也有学者提出,以时间窗作为指导溶栓的唯一指标存在 局限性,应客观评估患者脑组织病理生理进程而判断溶栓是否能使患 者获益[2]。随着我国影像技术的飞速发展,多模式磁共振成像(MRI)在 AIS诊治中也具有较好的应用效果,其中弥散加权成像(DWI)、液体衰 减反转恢复序列(FLAIR)、磁共振血管成像(MRA)均能辅助评估AIS的病 情进程,且近年来,DWI/FLAIR不匹配评估缺血半暗带状况受到学术界 广泛关注[3]。因此,本研究回顾性分析我院发病时间为4.5h~9h的210 例AIS患者资料,以评估多模式MRI在其诊治中的应用效果,现报告如 下。