利用SWI探讨不同程度脑微出血的急性脑梗死患者静脉溶栓风险

目的 探讨不同程度脑微出血的急性脑梗死患者进行静脉溶栓治疗的风险和预后情况。方法 收集确诊的急性脑梗死合并脑微出血的患者，经磁敏感加权成像扫描，根据脑微出血的数量分为A组（轻度组）45例、B组（中度组）68例和C组（重度组）42例，并选取同期单纯急性脑梗死患者为对照组（71例）。各组患者均采用常规的静脉溶栓治疗。利用磁敏感加权成像扫描比较各组治疗后脑微出血和出血性转化情况；用美国国立卫生院脑卒中量表和采用改良RANKIN量表比较各组患者的预后情况。结果 C组在静脉溶栓后脑微出血比治疗前有明显增加（P<0.05），出血性转化发生率和病死率明显高于对照组（P<0.05），预后情况劣于对照组（P<0.05）；A组和B组在静脉溶栓后脑微出血与治疗前比较，差异无统计学意义（P>0.05），预后情况、病死率与对照组无明显变化（P>0.05）；A组静脉溶栓后出血性转化发生率与对照组相当（P>0.05），而B组明显高于对照组（P<0.05）。结论 合并重度脑微出血的急性脑梗死患者静脉溶栓治疗可能会增加出血性转化危险和病死率，影响预后；利用磁敏感加权成像扫描明确患者的脑微出血情况对临床溶栓治疗有一定的指导意义。

Risk of Intravenous Thrombolysis in Acute Cerebral Infarction with Various Degree of Cerebral Microbleeds by SWI

Objective To investigate the risk and prognosis of intravenous thrombolytic therapy of acute cerebral infarction with various degrees of cerebral microbleeds (CMBs) by SWI. Methods According to the number of CMBs on SWI, the patients were classified into group A (mild group, 45 cases), group B (moderate group, 68 cases) and group C (Severe group, 42 cases), and patients with simple acute cerebral infarction in the same period were selectd as the control group (71 cases).Patients in each group were treated with conventional intravenous thrombolysis. Comparison of the CMBs and HT were compared by SWI after treatment in each group. The prognosis of each group was compared with NIHSS and mRS. Results CMBs of the group C after intravenous thrombolysis was significantly increased (P<0.05) than before, and the incidence of HT and mortality was significantly higher than the control group(P<0.05), and the prognosis was worse than the control group(P<0.05).CMBs of the group A and group B after intravenous thrombolysis had no significantly change (P>0.05) than before, and the prognosis, mortality had no significantly change (P>0.05) than the control group. The incidence of HT after intravenous thrombolysis in group A was comparable to that in the control group (P>0.05), while the group B was significantly higher than that in the control group (P<0.05). Conclusion Intravenous thrombolysis in acute cerebral infarction with severe CMBs may increase the risk of HT and mortality, affect the prognosis. The use of SWI in patients with CMBs clear on the clinical thrombolytic therapy have some significance.