重庆市长寿区人民医院神经内科，重庆 401220
费容(1977—)，女，副主任医师，大学本科，主要从事脑血管疾病方向的研究。Email：changshoufr@163.com。
Department of Neurology， People’s Hospital Changshou Chongqing， Chongqing 401220， China
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目的 探究扩散加权成像－液体衰减反转恢复序列(DWI-FLAIR)不匹配指导醒后缺血性脑卒中(WUIS)静脉溶栓疗效及安全性。方法 收集2017年1月至2020年10月在该院行静脉溶栓治疗DWI-FLAIR不匹配的82例WUIS患者临床资料（WUIS组），同时收集78例发病4.5 h内行静脉溶栓治疗的急性缺血性脑卒中(AIS)患者临床资料（AIS组）。记录两组基线资料、临床疗效及安全性。在治疗后90 d采用改良Rankin量表(mRS)评估两组预后情况。采用多因素Logistics回归分析评估影响WUIS患者不良预后的危险因素。结果 两组性别、年龄等基线资料比较，差异均无统计学意义(P>0.05)。两组溶栓后24 h临床疗效及溶栓后7 d颅内出血发生率、溶栓后90 d预后比较，差异均无统计学意义(P>0.05)。经多因素Logistics回归分析，发现高血压、糖尿病、高脂血症及后循环梗死均为影响WUIS患者不良预后的危险因素(P<0.05)。结论 DWI-FLAIR不匹配指导WUIS静脉溶栓治疗安全且有效，患者预后与病史及梗死部位相关，临床应对高危患者加强管理。
Objective To investigate the efficacy and safety of intravenous thrombolysis for wake-up ischemic stroke （WUIS） under the guidance of diffusion-weighted imaging and fluid-attenuated inversion recovery （DWI-FLAIR） mismatch.Methods A retrospective analysis was performed for the clinical data of 82 WUIS patients with DWI-FLAIR mismatch （WUIS group） who received intravenous thrombolysis in our hospital from January 2017 to October 2020 and 78 patients with acute ischemic stroke （AIS）（AIS group） who received intravenous thrombolysis within 4.5 hours after onset. Baseline data， clinical outcome， and safety were recorded for the two groups. Modified Rankin Scale （mRS） was used to evaluate prognosis at 90 days after treatment， and a multivariate logistic regression analysis was used to evaluate the risk factors for poor prognosis in patients with WUIS.Results There were no significant differences in the baseline data such as sex and age between the two groups （P>0.05）， and there were also no significant differences between the two groups in clinical outcome at 24 hours after thrombolysis， incidence rate of intracranial hemorrhage at 7 days after thrombolysis， and prognosis at 90 days after thrombolysis （P>0.05）. The multivariate logistic regression analysis showed that hypertension， diabetes mellitus， hyperlipidemia， and posterior circulation infarct were risk factors for poor prognosis in patients with WUIS （P<0.05）.Conclusions Intravenous thrombolysis is safe and effective for patients with WUIS under the guidance of DWI-FLAIR mismatch. The prognosis of patients is associated with medical history and infarct site， and it is necessary to strengthen the management of high-risk patients in clinical practice. ［Citation:Journal of International Neurology and Neurosurgery, 2021, 48(4): 339-342.］
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费容,文治成,贺传沙,盘毓敏456. DWI-FLAIR不匹配指导醒后缺血性脑卒中静脉溶栓疗效及安全性评价[J].国际神经病学神经外科学杂志,2021,48(4):339-342111FEI Rong, WEN Zhi-Cheng, HE Chuan-Sha, PAN Yu-Min222. Efficacy and safety of intravenous thrombolysis for wake-up ischemic stroke under the guidance of diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch[J]. Journal of International Neurology and Neurosurgery,2021,48(4):339-342
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- 收稿日期:2021-01-12
- 最后修改日期:2021-04-20
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- 在线发布日期: 2021-09-23
