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目的:探讨CT评价指导的觉醒型缺血性卒中(WUS)患者的静脉溶栓预后效果。方法:采用回顾性研究方法,以2013-02-2016-01在神经内科就诊的WUS患者120例为研究对象,均进行头部CT检查,判断静脉溶栓的入选对象。纳入溶栓治疗的患者都给予rt-PA静脉溶栓治疗,没有纳入溶栓治疗的患者均给予常规治疗,观察2组预后情况。结果:经过CT快速评价指导,120例患者中有40例进行静脉溶栓治疗(观察组),80例患者没有进行静脉溶栓治疗(对照组),2组rCBV值比较差异无统计学意义。观察组的rCBF与rMTT值与对照组比较差异有统计学意义(P<0.05)。观察组的治疗有效率为97.5%,对照组为81.3%,观察组的明显高于对照组(P<0.05);观察组的症状性脑出血发生率也明显少于对照组(P<0.05)。结论:CT评价指导下筛选出部分觉醒型缺血性卒中进行溶栓治疗能促使脑血流尽早恢复灌注,挽救缺血半暗带,有利于改善预后。
Objective: To investigate the prognostic value of intravenous thrombolysis in patients with awake ischemic stroke (WUS) guided by CT. Methods: A retrospective study was conducted on 120 cases of WUS patients treated in neurology department from February 2013 to May 2016 with head CT examination, and the venous thrombolysis was evaluated. Patients enrolled in thrombolytic therapy were given rt-PA intravenous thrombolysis. Patients without thrombolysis were given conventional therapy and the prognosis was observed in both groups. Results: After rapid evaluation of CT, 40 of 120 patients underwent intravenous thrombolysis (observation group), 80 patients did not receive intravenous thrombolysis (control group). There was no significant difference in rCBV between the two groups. The rCBF and rMTT values in the observation group were significantly different from those in the control group (P <0.05). The effective rate of treatment in observation group was 97.5% and in control group was 81.3%, the observation group was significantly higher than that in control group (P <0.05). The incidence of symptomatic intracerebral hemorrhage in observation group was also significantly less than that in control group (P <0.05) . CONCLUSION: Thrombolytic therapy of partially awake ischemic stroke under the guidance of CT evaluation can promote cerebral blood flow to resume perfusion as soon as possible and save ischemic penumbra, which is beneficial to improve prognosis.