| ObjectivesTo explore the efficacy and safety of early thrombolytic therapy for acute cerebral infarction guided by CT perfusion imaging.By evaluating CT perfusion imaging changes in cerebral hemodynamic parameters before and after thrombolysis in acute cerebral infarction,to explore the value of CT perfusion imaging parameters in the evaluation of thrombolytic efficacy in acute cerebral infarction and to find the most valuable parameters for judging the curative effect.Methods During the period from October 2016 to November 2018,28 patients with ischemic penumbra were examined by CTP as CTP group.A total of 87 patients with conventional time thrombolysis were enrolled,28 patients who received no statistically significant clinical data(age,gender,diabetes,hypertension,hyperlipidemia,coronary heart disease,smoking history and BMI index)and no statistically significant differences in prethrombotic NIHSS scores were used as reference groups,ie,conventional time thrombolysis.The CTP group underwent CT plain and CT perfusion examination by 256-slice spiral CT,and the re-examination was performed again after 7 days.Perfusion parameters pseudo-color map of patient was obtained by post-processing software,and the relative values of perfusion parameters(CBF,CBV,MTT and TTP)in the core infarct zone and the ischemic penumbra before and after thrombolysis were measured.The National Institutes of Health Stroke Scale(NIHSS)score and modified Rankin(mRS)score before admission to both groups,and NIHSS scores at 24 h,7d,14 d,and 30 d after thrombolysis,and 30 d and 90 d mRS scores after thrombolysis were recorded.The efficacy,good prognosis rate and hemorrhagic transformation rate of the two groups were compared after thrombolytic therapy;The relative values of CT perfusion parameters in the core infarct area and ischemic penumbra before thrombolysis were compared in the CTP group;The relative changes of CT perfusion parameters in the core infarction area and the ischemic penumbra before and after thrombolysis were compared,and the correlation between the difference before and after thrombolysis of each parameter and the difference in NIHSS score were analyzed.Results After thrombolytic therapy in CTP group,the NIHSS scores at 24 h,7d,14 d and 30 d were better than the conventional time thrombolysis group.The difference was statistically significant(P<0.05),the NIHSS scores of the CTP group at 24 h,7d,14 d and 30 d after thrombolysis were lower than those before thrombolysis(P<0.05),the NIHSS scores of the conventional time thrombolysis group were lower than those before thrombolysis at 14 and 30 days after thrombolysis(P<0.05),there was no significant difference in the NIHSS scores between the 24 th and 7th day after thrombolysis(P=4.416,12.155);the good prognosis rate of CTP group was 64.3% and 89.3% at 30 d and 90 d,which was higher than that of conventional time thrombolysis group(35.7% and 60.7%).The difference between the two groups was statistically significant(P<0.05);In the CTP group,1 case of symptomatic intracranial hemorrhage was transformed within 24 hours,and 6 cases of symptomatic intracranial hemorrhage in the routine time thrombolysis group.The bleeding rate of CTP group was lower than that of the conventional time thrombolysis group,the difference was statistically significant(P<0.05);The rCBF and rCBV values in the ischemic penumbra of the CTP group were higher than those in the core infarction area.The rTTP and rMTT values in the ischemic penumbra were delayed compared with the core infarction area,and the difference was statistically significant(P<0.05);Before thrombolysis and 7 days after thrombolysis,the difference of rCBF,rCBV and rMTT in the ischemic penumbra of CTP group was correlated with the difference of NIHSS score(P<0.05),There was no correlation between the difference of rTTP and the NIHSS score in the ischemic penumbra(P>0.05),and the difference between rMTT and NIHSS score was the highest correlation(r=0.402).Before and after thrombolytic therapy,the rCBF of the ischemic penumbra increased in the CTP group,the difference was statistically significant(P<0.05),and the rCBV increased slightly,but the difference was not statistically significant.rMTT and rTTP were shorter than before,and the difference was statistically significant(P<0.05).Before and after thrombolysis,the rCBF and rCBV in the core infarction area of the CTP group increased slightly,but the difference was not statistically significant.The rMTT and rTTP were slightly shortened,but the difference was not statistically significant.Conclusions 1 Thrombolytic therapy under CT perfusion imaging is more effective,benign prognosis and safety than thrombolysis under conventional time guidance,and can be Acute cerebral infarction within 6 hours.It plays an important diagnostic value in the treatment of infarction;2 CT perfusion imaging can quantitatively evaluate changes in cerebral hemodynamics before and after treatment,there was no correlation between changes in rTTP parameters and changes in NIHSS scores,the changes of rCBF,rCBV and rMTT parameters were related to the changes of NIHSS scores.The correlation of rMTT was the best,which was helpful for the clinical evaluation of acute cerebral infarction.Figure6;Table8;Reference 103... |
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