替罗非班联合小剂量肝素治疗老年人进展性卒中疗效分析

Efficacy and security of combinations of tirofiban with low-dose heparin in the treatment of progressingstroke of the elderly

目的探讨替罗非班联合小剂量肝素治疗进展性卒中合并颅内外血管狭窄的疗效，进一步分析替罗非班在缺血性卒中治疗中的价值。方法回顾性收集26例应用替罗非班联合小剂量肝素治疗进展性卒中患者的资料，以起病6h-7d内美国国立卫生研究院卒中量表（NIHSS）增加≥3分为进展性卒中诊断标准，采用CT血管成像检查（CTA）诊断颅内外血管狭窄并判定其狭窄程度。结果进展性卒中患者并发颅内外血管狭窄j闭塞为（88．5％）明显高于无颅内外血管狭窄/无症状性血管狭窄组（11．5％）（X^2=14．79，P=0．000）。治疗前两组NIHSS评分差异有统计学意义（t=2．17，p=0．046），治疗后两组出院时NIHSS评分明显降低（t=3．59，P=0．021）；治疗后改良Ranking量表（mRS）评分无血管闭塞组较血管闭塞组低（t=6．79，P=0．001）。无颅内外血管狭窄／中度狭窄以下组的进展性卒中疗效（60．2％）明显高于颅内外血管重度狭窄／闭塞组（30．8％）（X^2=4．35，P〈0．05）。颅内外血管狭窄程度与NIHSS评分和mRS评分呈负相关（r=-0．988、0．859）。结论替罗非班联合小剂量肝素治疗进展性卒中是有效的，颅内血管狭窄程度与进展性卒中的预后相关。

Objective To investigate the efficacy and security of tirofiban with low-dose heparin for treating progressing stroke with intracranial vessel stenosis, to analyze the clinical value of tirofiban in the treatment of ischemic stroke. Methods Clinical data of 26 patients treated with tirofiban and low-dose heparin for progressing stroke were retrospectively collected with NIHSS increment ≥3 within 6 days of stroke as the diagnosis standard. The degree of intracranial vessel stenosis was checked by CT angiography （CTA）. The efficacy of tirofiban for treating progressing stroke, and the correlation between the degree of intracranial vessel stenosis and the prognosis of progressing stroke were observed. Results The percentage of progressing stroke patients with intracranial vessel stenosis/lesion was higher than without intracranial vessel stenosis/lesion （88.5 vs. 11.5%, X^2=14.786, P=0.000）. There was a significant difference in NIHSS scores between progressing stroke patients with and without intracranial vessel stenosis/lesion before treatment （t=2.17, P=0. 046）. NIHSS scores were significantly decreased （t=3.59, P 0. 021） in both two groups after treatment. MRS was lower in progressing stroke patients without intracranial vessel stenosis/lesion than in progressing stroke patients with intracranial vessel stenosis/lesion after treatment （t=6.79, P=0. 001）. The efficacy of tirofiban was higher in progressing stroke patients without intracranial vessel stenosis/lesion than in progressing stroke patients with intracranial vessel stenosis/lesion （60.2% vs. 30.8%, ）X^2 = 4.35, P〈0.05）. Conclusions Combination of tirofiban with low dose heparin is safe and effective in the treatment of progressing stroke. The degree of intracranial vessel stenosis is correalted with progressing stroke prognosis.