41 岁男子急性脑梗死,溶栓后症状有好转 T:36.5℃,P 80 次/分,R 19 次/分,BP115/78 mmHg 体重 60 kg 神志清, 两瞳孔等大等圆,直径约 2.5 mm, 对光反射灵敏, 右侧眼角变小, 双侧额纹等对, 双侧鼻唇沟等对, 伸舌居中, 右侧软腭稍低于左侧, 颈软, 气管居中, 两肺呼吸音清,HR 80 次/分, 律齐, 腹平软, 肝脾肋下未及, 右侧肢体肌力正常,左侧肢体痛温觉消失,右侧面部痛温觉减退,触觉,位置觉、运动觉正常,Babinski 征(-)。 溶栓 48 h 后 CTA 发现动脉瘤 10 小时后头颅磁共振检查:右侧延髓背侧急性脑梗死。如下图 颅内动脉瘤全都不能溶栓吗? rt –PA 静脉溶栓最为严重的并发症是症状性颅内出血 (sICH) ,可明显增加溶栓患者的死亡率和病残率[1]。 题图 | 作者提供 参考文献: [1]EMBERSON J,LEES K R,LYDEN P,et al. Effect of treatmentdelay,age,and stroke severity on the effects of intravenousthrombolysis with alteplase for acute ischaemic stroke: a meta -analysis of individual patient data from randomised trials [J].Lancet,2014,384 ( 9958) : 1929 -1935. [3]JAUCH E C,SAVER J L,ADAMS H P J R,et al. Guidelines for the early management of patients with acute ischemic stroke: a guidelinefor healthcare professionals from the American Heart Association American Stroke Association [J].Stroke,2013,44 ( 3 ) : 870-947. [4]Katsanos A,Aristeidis H,Zand R,et al. Systemic thrombolysis in acute ischemic stroke patients with unruptured intracranial aneurysms[J]. Neurology: Official Journal of the American Academy of Neurology,2015,85( 17) : 1452-1458. [5]Zhang CH,Li C,Wang YX,et al. Efficacy and Safety of intravenous thrombolysis for the treatment of acute ischemic stroke patients withsaccular intracranial aneurysms of ≤ 3 mm[J].Cell Biochemistry &Biophysics,2015,72( 3) : 889-893 [6] 康慧斌,彭汤明,钱增辉,等. 颅内动脉瘤破裂风险因素分析 [J]. 中华神经医学杂志,2014,13( 4) : 402-404. [7] 吴 璇,张新江,段作伟. 急性脑梗死患者合并颅内未破裂动脉瘤的危险因素及早期预后分析 [J]. 中华神经科杂志,2019,52( 4) : 288-297. [8] Edwards NJ,Kamel H,Josephson SA.The safety of intravenous thrombolysis for ischemic stroke in patients with pre-existing cerebral aneurysms: a case series and review of the literature[J].Stroke,2012,43( 2) : 412-416 [9] Ishibashi T,Murayama Y,Urashima M,et al. Unruptured intracranial aneurysms: incidence of rupture and risk factors[J].Stroke,2009,40( 1) : 313-316. |
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