| Objective:In this study,the clinical and imaging data of thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke were retrospectively analyzed to explore the clinical study of transcranial Doppler ultrasound(TCD)combined with magnetic resonance angiography(MRA),to evaluate the blood vessels and prognosis of patients with thrombolysis.In order to guide the secondary prevention and rehabilitation of patients with stroke.Methods:This study retrospectively analyzed the clinical and imaging data of 60 patients with acute ischemic stroke,who were admitted to the Department of Neurology of the first Hospital of Hohhot from June 2018 to January 2020.The onset time window was 0-4.5h and received rt-PA intravenous thrombolysis.According to the changes of 24-hour neurological function,the subjects were divided into two groups: neurological deterioration group(24-hour NIHSS score increased by 4 points compared with pre-thrombolysis score and death)and neurological function improvement group(24-hour NIHSS score decreased less than 4 points compared with pre-thrombolytic score or NIHSS score ?1).According to the modified Rankin scale(m RS),the quality of life of patients with thrombolysis at 90 days after onset was evaluated.The patients were divided into two groups: good prognosis group with m RS(score ? 2)and poor prognosis group with m RS(score>2).The patients were examined by MRA and TCD 24 hours after thrombolysis.According to the modified thrombolysis in cerebral infarction(m-TICI)grade of magnetic resonance angiography and the thrombolysis in brain ischemia(TIBI)grade of transcranial Doppler cerebral ischemic thrombolysis flow,the blood vessels of the patients were divided into the following categories: 1.MRA occlusion + TCD occlusion;2.MRA occlusion + partial patency of TCD;3.MRA occlusion + complete patency of TCD;4.partial occlusion of MRA + partial recanalization of TCD;5.partial activation of MRA + full activation of TCD;6.full activation of MRA + full activation of TCD.The general indexes of the patients(systolic blood pressure at admission,diastolic blood pressure at admission,door to needle time(DNT)at admission to thrombolysis,random blood glucose,total cholesterol,triglyceride,low density lipoprotein cholesterol,homocysteine,NIHSS score before thrombolysis)and clinical data(sex,age,hypertension,coronary heart disease,atrial fibrillation,diabetes,smoking and drinking history)were recorded.The changes of 24-hour neurological function and 90-day prognosis of patients with different blood vessels were analyzed,and the related factors affecting the changes of 24-hour neurological function and90-day prognosis were analyzed.Results:1.Analysis of the changes of neurological function at 24 hours after thrombolysis and the prognosis of 90 days after thrombolysis in patients with different blood vessels:(1)In the neurological deterioration group 24 hours after thrombolysis,the proportion of patients with MRA occlusion + TCD occlusion(21.4% vs 2.2%,P=0.036)and partial opening of TCD(57.1% vs 17.4%,P=0.009)was higher than that in the improved group,and the percentage of patients with complete opening of MRA and full opening of TCD(0 vs34.8%,P=0.026)was higher than that in the improved group.The proportion of patients was lower than that in the neurological function improvement group,and the difference was statistically significant(P < 0.05).(2)In the group with poor prognosis 90 days after onset,the vascular occlusion was MRA occlusion + TCD occlusion(25.0% vs 2.1%,P=0.023),MRA partially opened + TCD partially opened(50% vs 8.3%,P= 0.002).The proportion of patients was higher than that in the group with good prognosis.MRA occlusion + TCD partially opened(0 vs 33.3%,P=0.049),MRA fully opened + TCD fully opened(0 vs33.3%,P =0.049),the proportion of patients was lower than that of patients with good prognosis,and the difference was statistically significant(P<0.05).There was no significant difference in MRA occlusion + full opening of TCD and partial opening of MRA + full opening of TCD in the above two cases(P >0.05).2.Analysis of related factors on the changes of neurological function 24 hours after thrombolysis and the prognosis of 90 days after onset:(1)univariate analysis showed that in the neurological deterioration group 24 hours after thrombolysis,systolic blood pressure at admission(167.36 ±15.99 vs 135.83 ±15.98,P <0.01),random blood glucose(6.62 ±1.60 vs 5.26 ±1.25,P <0.01),triglyceride(6.04 ±29.40 vs 1.26 ±0.69,P =0.049),The NIHSS score before thrombolysis(16.29 ±6.68 vs 8.17 ±4.58,P = 0.021)was higher than that in the neurological function improvement group,the proportion of patients with a history of atrial fibrillation(28.6% vs 2.2%,P=0.01)and drinking history(57.1% vs 19.6%,P=0.017)was higher than that in the neurological function improvement group,and the difference was statistically significant(P<0.05).(2)Univariate analysis showed that in the group with poor prognosis at 90 days after onset,age(69.00 ±9.82 vs 59.63±10.69,P=0.008),systolic blood pressure(164.50 ±20.04 vs 136.04 ±18.86,P <0.01),random blood glucose(7.31±1.57 vs 5.42 ±1.40,P < 0.01),homocysteine(26.38 ±17.18 vs 14.47 ±4.49,P < 0.01),The NIHSS score before thrombolysis(17.17 ±6.83 vs 8.23 ±4.50,P=0.032)was higher than that in the group with good prognosis,and the proportion of patients with drinking history(58.3% vs 2.8%,P=0.026)was higher than that in the group with good prognosis,and the difference was statistically significant(P <0.05).Conclusions:1.The combination of TCD and MRA can be used to evaluate the blood vessels 24 hours after intravenous thrombolysis in patients with acute ischemic stroke.the neurological function changes of different vessels at 24 hours and the prognosis at 90 days after onset are different:(1)MRA and TCD are completely opened,the neurological function is improved at 24 hours after thrombolysis,the prognosis is good at 90 days after thrombolysis.(2)TCD and MRA are completely occluded,the neurological function of patients deteriorates at 24 hours after thrombolysis,and the prognosis is poor at 90 days after thrombolysis.(3)MRA occlusion + partial opening of TCD,patients with deterioration of neurological function at 24 hours after thrombolysis and good prognosis at 90 days after onset.(4)partial opening of MRA and partial opening of TCD,There was no significant difference in neurological function changes between the two groups at 24 hours,but the proportion of patients in the neurological function improvement group was higher than that in the neurological function deterioration group,and the prognosis was poor 90 days after onset.2.Admission systolic blood pressure,random blood glucose,triglyceride,NIHSS score before thrombolysis and drinking history were the risk factors of neurological deterioration in 24 hours and poor prognosis 90 days after discharge in patients with acute ischemic stroke after intravenous thrombolysis.The previous history of atrial fibrillation has an effect on the deterioration of 24-hour neurological function,while the elderly and homocysteine have an effect on the poor prognosis of the patients after 90 days of onset. |
PDF Full Text Request