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目的了解急性脑梗死患者静脉溶栓前实施MRI检查的可行性及安全性。方法采用包含MRI检查的优化溶栓流程,对我院2010年4月至2012年5月的急性脑梗死患者进行了静脉溶栓。观察并记录患者的发病-溶栓时间(onset to treatment time,OTT)、急诊-溶栓时间(door to needle time,DNT)以及溶栓后的临床转归;并将其与国内外公开发表、采用CT检查流程的静脉溶栓研究的同类数据进行比较。结果本组108例静脉溶栓患者中溶栓前行MRI检查的100例(92.6%)。溶栓前所耗时间:发病-溶栓的中位时间为180 min、急诊-溶栓中位时间为85 min。溶栓后90 d时良好结局的(改良Rankin评分0～1分)比例为50.9%(55/108)、症状性颅内出血率为3.7%(4/108)。与采用CT检查的同类对照研究数据相比,溶栓前所耗时间小于中国国家卒中注册研究的结果;溶栓后90 d时的良好结局及症状性颅内出血率均显著优于赫尔辛基注册研究的数据(P<0.05,P<0.01)。结论优化流程下的MRI检查未延误患者的溶栓时间,也未恶化溶栓患者的临床转归,故静脉溶栓前行MRI检查安全、可行。
Objective To investigate the feasibility and safety of MRI before venous thrombolysis in patients with acute cerebral infarction. Methods Thrombolysis was performed in patients with acute cerebral infarction from April 2010 to May 2012 in our hospital with optimized thrombolysis procedure including MRI. The incidence of patients with onset-to-treat time (OTT), emergency-to-door time (DNT) and clinical outcome after thrombolysis were observed and recorded. The results were compared with those published at home and abroad, Similar data from venous thrombolysis studies using the CT examination procedure were compared. Results The group of 108 patients with intravenous thrombolysis before thrombolysis MRI examination of 100 cases (92.6%). Time before thrombolysis: onset - the median time of thrombolysis was 180 min, emergency - thrombolytic median time was 85 min. At 90 days after thrombolysis, the favorable outcome (modified Rankin score 0 to 1) was 50.9% (55/108) and the symptomatic intracranial hemorrhage was 3.7% (4/108). The time taken prior to thrombolysis was less than the results of the National Register of Stroke Study in China compared with similar controlled studies using CT; the favorable outcome at 90 days after thrombolysis and the symptomatic intracranial hemorrhage were significantly better than those from the Helsinki Registry Study Data (P <0.05, P <0.01). Conclusion MRI examination under optimized procedure has not delayed the thrombolysis time of patients and has not deteriorated the clinical outcome of thrombolysis. Therefore, MRI examination before thrombolysis is safe and feasible.