MCA闭塞患者溶栓前后TIBI分级、TCD血流反转的临床意义

doi:10.7517/issn.1674-0475.211116

摘要/Abstract

摘要： 本研究探讨急性大脑中动脉(MCA)闭塞型脑卒中患者经颅多普勒(TCD)评估脑缺血溶栓血流分级(TIBI)、TCD血流反转与患者预后的关系。选取144例MCA闭塞型脑卒中患者作为研究对象,所有患者均采用阿替普酶静脉溶栓治疗,根据患者起病90 d内的预后结局分为预后良好组(98例)和预后不良组(46例);对比两组患者溶栓前后的脑缺血溶栓血流分级(TIBI)、TCD血流反转情况。术后24 h再次复查,预后良好组的TIBI分级分布优于预后不良组(P<0.05);TIBI血流改善、TCD血流反转率预测MCA闭塞型脑卒中患者溶栓治疗后预后的AUC值分别为0.757、0.578;入院时NIHSS评分较高及合并糖尿病、冠心病、房颤会显著增大患者预后不良的风险(P<0.05),溶栓后患者TIBI血流改善、TCD血流反转则可降低患者出现不良预后的风险(P<0.05)。通过早期观察患者溶栓治疗后的TIBI分级改善情况、TCD血流反转情况,对于评估患者预后具有一定的临床价值,二者可有效互补。

关键词: 经颅多普勒, 大脑中动脉闭塞, 脑卒中, 预后

Abstract: This study explored the relationship between the transcranial Doppler (TCD) assessment of cerebral ischemia thrombolytic classification (TIBI), TCD blood flow reversal and the prognosis of patients with acute middle cerebral artery (MCA) occlusive stroke. Chosen 144 MCA occlusive stroke patients as the research objects, all patients were treated with intravenous alteplase thrombolysis. According to the prognosis of patients within 90 days of onset, they were divided into a good prognosis group with 98 cases and a poor prognosis group with 46 cases, and compared the cerebral ischemia thrombolysis classification (TIBI) and TCD blood flow reversal before and after thrombolysis between the two groups. Re-examined 24 hours after the operation, the TIBI blood flow classification distribution of the good prognosis group was better than that of the poor prognosis group (P<0.05). The AUC values of TIBI blood flow improvement and TCD blood flow reversal rate predicted the prognosis of patients with MCA occlusive stroke after thrombolytic therapy were 0.757 and 0.578, respectively. The higher NIHSS scores, diabetes, coronary heart disease, and atrial fibrillation at admission would significantly increase the risk of poor prognosis on admission (P<0.05). After thrombolysis, TIBI blood flow was improved and TCD blood flow was improved and reversal reduced the risk of poor prognosis in patients (P<0.05). Through early observation of TIBI blood flow improvement after thrombolytic therapy and TCD blood flow reversal could have a certain clinical value for evaluating the prognosis of patients, and the two can effectively complement each other.

Key words: transcranial Doppler, middle cerebral artery occlusion, stroke, prognosis

陈尚超, 胡明艳. MCA闭塞患者溶栓前后TIBI分级、TCD血流反转的临床意义[J]. 影像科学与光化学, 2022, 40(3): 459-463.

CHEN Shangchao, HU Mingyan. The Clinical Significance of TIBI Classification and TCD Blood Flow Reversal before and after Thrombolysis in MCA Occlusion Patients[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(3): 459-463.

参考文献

[1] 潘延平, 陈建玲, 刘小丽. 急性前循环脑梗死静脉溶栓患者TIBI分级与血管再通和预后的相关性研究[J]. 贵州医药, 2020,44(12):1923-1924.
[2] 段小玲. 急性脑梗死溶栓治疗患者血管再通状况及其影响因素分析[J]. 临床医学工程, 2021,28(5):701-702.
[3] 蒋婷, 夏春潮, 崔福涛, 等. 大脑中动脉斑块特征对急性脑梗死患者预后的预测价值[J]. 实用医院临床杂志, 2021,18(3):122-124.
[4] 卢林, 马国昭, 崔元孝, 等. 脑梗塞急性期经颅多普勒检测脑血流分级临床应用研究[C]. 泰安:山东省2013年神经内科学学术会议暨中国神经免疫大会2013论文汇编, 2013.
[5] 吕滨, 郎黎明. TCD评价脑血流的自动调节功能[C]. 昆明:全国颅脑及颈动脉超声学术会议, 2007.
[6] 徐丹. 低频超声在大脑中动脉狭窄急性脑梗死治疗中的应用价值[J]. 中国卫生标准管理, 2020,11(4):58-60.
[7] Demchuk A M, Burgin W S, Christou I, et al. Thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator[J]. Stroke, 2001,32(1):89-93.
[8] Lansberg M G, Christensen S, Kemp S, et al. Computed tomographic perfusion to predict response to recanalization in ischemic stroke[J]. Annals of Neurology, 2017,81(6):849-856.
[9] 皮成慧, 王君, 张荣举, 等. 颅内侧支循环对急性脑梗死患者预后影响的研究进展[J]. 中国脑血管病杂志, 2018,15(4):212-215.
[10] 张岐平, 陈英道, 李育英, 等. 侧支循环的建立对急性脑梗死患者神经功能及预后的影响[J]. 实用医学杂志, 2016,32(7):1040-1043.
[11] 夏金超, 汪勇锋, 张坤, 等. 血管内再通术治疗症状性慢性大脑中动脉闭塞的初步临床观察[J]. 中华神经外科杂志, 2021,37(1):49-53.
[12] 姜辉. 急性大脑中动脉梗死CTA-血栓负荷评分与TCD血流反转对预后评估及二者关系[D]. 衡阳:南华大学, 2019.
[13] 谢静. 经颅多普勒血流动力学分型对大脑中动脉急性脑梗死患者预后的评估价值[J]. 海南医学院学报, 2016,22(15):1741-1744, 1748.
[14] 邢英琦, 韩珂, 白竹, 等. 经颅多普勒超声脑血流次序改变对大脑中动脉慢性闭塞的诊断价值[J]. 中国老年学, 2008,28(19):1906-1909.
[15] 石以. 经颅彩色多普勒超声联合颈动脉血管超声对大脑中动脉粥样硬化性脑梗死诊断分析[J]. 中国保健营养, 2017,27(16):314-315.