【摘要】 目的比较早期"干性治疗"与传统的治疗疗法对静脉溶栓后急性幕上大面积脑梗死急性期恶性事件及90天预后的影响。方法前瞻性收集2015年1月—2017年12月我院神经科住院治疗并行静脉溶栓的急性幕上大面积梗死患者92例,急诊均经头颅CT除外脑出血后随机分为"干性治疗"组和传统治疗组;"干性治疗"组在入院72小时内维持血压在140～150 mmHg,每日限液量1 000 ml、禁用血管扩张药物。抗聚、降脂同常规并在72小时后恢复扩容、活血常规治疗。传统治疗组除常规抗聚、降脂外,入院即行扩容、血管活性药物治疗。比较两组患者:14天内恶性事件(恶性脑水肿、进展性致死性脑梗死、出血转化)发生率和死亡率、90天预后率(良好MRS 0～2分,不良MRS3～5分)及90天病死率。结果"干性治疗"组14天内发生进展性致死性脑梗死4例,死亡4例,90天内死亡11例,预后良好2例,不良33例;传统治疗中14天内发生恶性脑水肿12例,出血转化6例,死亡14例,90天内死亡15例,预后良好1例,不良29例;两组患者14天内恶性事件比较差异有统计学意义(χ2=14.000,P=0.000 2),14天内死亡率比较差异有统计学意义(χ2=9.600,P=0.002);90天预后差异无统计学意义(χ2=0.791,P=0.374)。90天病死率差异无统计学意义(χ2=2.029,P=0.154)。结论静脉溶栓后早期"干性治疗"可以减低急性幕上大面积脑梗死14天内恶性事件发生率和病死率;但是对于90天预后及病死率影响不大。更多还原

【Abstract】 Objective To compared the effect of early"dry therapy"and traditional therapy on early malignant events and 90-day prognosis of acute supratentorial massive cerebral infarction after intravenous thrombolysis. Methods A prospective study of 92 patients with massive supratentorial infarction treated with intravenous thrombolytic therapy in neurology from January 2015 to December 2017 in our hospital was carried out, all emergency cases were randomly divided into"dry therapy"group and "traditional therapy" group after exception of intracerebral hemorrhage with the cranial CT. The"dry therapy"group maintained blood pressure at 140~150 mm Hg within 72 hours, the limit of liquid per day was 1 000 ml, prohibition of vasodilators, but anti-polymerization, lipid-lowering was used as usual. After 72 hours, the blood volume expansion was resumed, and the traditional therapy of promoting blood circulation was carried out. The "traditional therapy" group was treated with traditional anti-polymerization, lipid-lowering, blood volume expansion and promoting blood circulation. Compared the two groups of patients: incidence of malignant events(malignant cerebral edema, progressive fatal cerebral infarction, hemorrhage conversion) and mortality within 14 days, 90-day good recovery rate( MRS 0~2 points: good, MRS 3~5 points: bad) and 90-day mortality. Results In "dry therapy" group: 4 cases of progressive cerebral infarction and 4 death cases within 14 days, 11 cases died within 90 days, 2 cases had good prognosis and 33 cases had bad prognosis. In "traditional therapy" group : malignant cerebral edema occurred in 12 cases, hemorrhage in 6 cases and 14 death cases within 14 days, 15 cases died within 90 days, 1 case had good prognosis and 29 cases had bad prognosis. There was a significant difference(χ2=14.000, P =0.0002) between the two groups of patients with malignant events within 14 days(χ2=9.600, P =0.002). There was no significant(χ2=0.791, P =0.374) difference in the prognosis of 90 days. There was no significant difference(χ2=2.029, P =0.154) in the death rate of 90 days. Conclusion Early "dry therapy" after intravenous thrombolysis can reduce the incidence and mortality of malignant events in 14 days after massive supratentorial cerebral infarction, but has little effect on the prognosis and mortality of 90 days.更多还原