影像科学与光化学 ›› 2022, Vol. 40 ›› Issue (3): 459-463.DOI: 10.7517/issn.1674-0475.211116

• 综述与论文 • 上一篇    下一篇

MCA闭塞患者溶栓前后TIBI分级、TCD血流反转的临床意义

陈尚超1, 胡明艳2   

  1. 1. 武汉钢铁(集团)公司第二职工医院, 湖北 武汉 430085;
    2. 武汉市中心医院, 湖北 武汉 430014
  • 收稿日期:2021-11-08 出版日期:2022-05-15 发布日期:2022-05-27

The Clinical Significance of TIBI Classification and TCD Blood Flow Reversal before and after Thrombolysis in MCA Occlusion Patients

CHEN Shangchao1, HU Mingyan2   

  1. 1. The Second Hospital of WISCO, Wuhan 430085, Hubei, P. R. China;
    2. Wuhan Central Hospital, Wuhan 430014, Hubei, P. R. China
  • Received:2021-11-08 Online:2022-05-15 Published:2022-05-27

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