發(fā)布時間：2018-01-15 04:19

  本文關鍵詞：腦內深部靜脈與急性缺血性卒中靜脈溶栓后遠期預后的相關性研究　出處：《浙江大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 磁敏感成像 急性缺血性腦卒中 靜脈溶栓治療 丘紋靜脈

【摘要】：背景與目的腦內深部靜脈對急性缺血性卒中(acute ischemic stroke,AIS)患者靜脈溶栓后神經功能結局的影響目前尚不明確。本研究旨在觀察AIS磁敏感影像(Susceptibility-weighted imaging,SWI)上的靜脈表現(xiàn),并探討其與靜脈溶栓后遠期功能結局的關系。材料與方法我們回顧2011年9月至2015年7月期間發(fā)病6小時內在浙江大學附屬第二醫(yī)院神經內科接受靜脈阿替普酶(recombinant tissue plasminogen activator,rt-PA)溶栓治療的AIS且溶栓前行多模式磁共振檢查的患者。利用SWI重建影像評估靜脈,測定雙側丘紋靜脈(thalamostriate vein,TSV),隔靜脈(septal vein,SV),大腦內靜脈(internal cerebral vein,ICV)的信號密度值,計算雙側靜脈的相對信號差率(signal difference ratio,SDR)。溶栓后24小時灌注恢復≥70%定義為成功再灌。3 月改良 Rankin 評分(3 month-modified Rankin Scale,3m-mRS)2 分定義為預后不良,分析TSV,SV,ICV的SDR與靜脈溶栓后遠期預后的關系。研究結果共109例患者納入分析,只有TSV的SDR與靜脈溶栓后遠期預后不良(3m-mRS2)(ρ= 0.25,p = 0.008)顯著相關,其預測預后不良的最佳閾值為SDR4.8%(敏感性為 53.7%,特異性為 80.9%)。而 SV(ρ=0.04,p = 0.73)或 ICV(ρ=0.07,p = 0.47)的SDR與預后無相關性。我們定義TSV的SDR≥5%為"患側丘紋靜脈明顯(ipsilateral prominent TSV,IPTSV)"。共 35 例(32.1%)存在 IPTSV。與無IPTSV征象的患者相比,具有IPTSV征象的患者獲得成功再灌的比例更低(37.5%vs 60.0%,OR = 0.35,95%CI 0.13-0.92,p = 0.03),且更可能遠期預后不良(62.9%vs 25.7%,OR = 3.66,95%CI 1.25-10.68,p = 0.02)。在具有 IPTSV 征象的患者中,未達到成功再灌者更易遠期預后不良(80.0%vs44.4%,p = 0.04)。研究結論基線IPTSV征象提示靜脈溶栓后成功再灌率較低,且具有該征象的患者更易遠期預后不良。對于此類患者,可能需要進一步的再灌注治療。
[Abstract]:Background & objective to treat acute ischemic stroke in acute ischemic stroke with deep cerebral vein. The effect of neurologic outcome after intravenous thrombolytic therapy in patients with AIS was not clear. The purpose of this study was to observe the magnetic sensitivity imaging of AIS (. Susceptibility-weighted imaging. The venous manifestations on SWI. Materials and methods We reviewed the clinical efficacy of intravenous thrombolytic therapy in the Department of Neurology of the second affiliated Hospital of Zhejiang University within 6 hours of onset from September 2011 to July 2015. Matipase (. Recombinant tissue plasminogen activator. Patients with AIS treated with rt-PA and multimode MRI before thrombolytic therapy. Vein was evaluated by SWI reconstruction imaging. The bilateral papular vein thalamostriate TSVV and septal vein in SVS were measured. The signal density of internal cerebral vein (cerebral). The relative signal difference ratio was calculated. 24 hours after thrombolytic thrombolysis 鈮，

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