Jørgensen H S, Sperling B, Nakayama H, Raaschou H O, Olsen T S
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Arch Neurol. 1994 Sep;51(9):865-73. doi: 10.1001/archneur.1994.00540210037011.
To determine the incidence, time course, and clinical importance of spontaneous reperfusion of cerebral infarcts in patients with acute stroke.
Prospective, community based.
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Included in the incidence and time course study were 354 unselected patients with acute ischemic stroke. Clinical outcome was studied in a subgroup of 36 patients admitted on the day of stroke onset and in whom it was known whether spontaneous reperfusion occurred within the first week after stroke onset.
Computed tomography and single photon emission computed tomography, with technetium Tc 99m exametazime used as a flow tracer. The Scandinavian Stroke Scale neurologic score was determined on admission, 1 and 2 weeks after stroke, and at discharge.
The incidence of spontaneous reperfusion was 77% in patients with cortical infarcts. The frequency of reperfusion increased rapidly from zero at the time of onset to 60% on day 7 after stroke, reaching a maximum on day 14, at which time 77% showed reperfusion. Marked clinical improvement was observed in patients with spontaneous reperfusion (P = .001), while no improvement occurred in patients without reperfusion. Reperfusion was not observed in subcortical infarcts.
The rate of spontaneous reperfusion increases gradually with time and occurs within the first 2 weeks after stroke onset in approximately four of five patients with cortical infarcts. Spontaneous reperfusion seemed to improve clinical outcome.
确定急性卒中患者脑梗死自发再灌注的发生率、时间进程及临床重要性。
基于社区的前瞻性研究。
丹麦哥本哈根比斯佩比约格医院神经内科。
纳入发生率及时间进程研究的为354例未经挑选的急性缺血性卒中患者。对卒中发病当天入院且已知卒中发病后第一周内是否发生自发再灌注的36例患者亚组进行了临床结局研究。
采用计算机断层扫描和单光子发射计算机断层扫描，以锝 Tc 99m 依沙美肟作为血流示踪剂。在入院时、卒中后1周和2周以及出院时测定斯堪的纳维亚卒中量表神经学评分。
皮质梗死患者的自发再灌注发生率为77%。再灌注频率从发病时的零迅速增加至卒中后第7天的60%，在第14天达到最高，此时77%的患者显示再灌注。自发再灌注患者观察到明显的临床改善（P = .001），而未再灌注患者无改善。皮质下梗死未观察到再灌注。
自发再灌注率随时间逐渐增加，在卒中发病后的前2周内，约五分之四的皮质梗死患者会发生自发再灌注。自发再灌注似乎改善了临床结局。
