联合运用尿激酶和替罗非班治疗急性脑梗死的安全性和有效性

Safety and efficacy of urokinase plus tirofiban in treatment of acute ischemic stroke patients

目的探讨联合运用尿激酶和替罗非班治疗脑梗死的安全性和有效性。方法 50例脑梗死患者于尿激酶溶栓治疗后随机分为两组:替罗非班组和对照组,每组各25例。替罗非班组静脉滴注尿激酶150万单位后立即开始予以替罗非班[首先静脉滴注替罗非班0.4μg/(kg·min),30分钟,然后持续静脉泵入替罗非班,0.1μg/(kg·min),72小时],对照组除不予替罗非班外,其他治疗同替罗非班组,观察两组14天内颅内外出血、14天内死亡、14天时美国国立卫生院卒中量表(NIHSS)评分、3个月时改良Rankin量表评分(mRS)等指标。结果两组间14天内的症状性颅内出血、颅内出血、颅内外出血发生率、病死率的差异均无统计学意义(P>0.05);14天时替罗非班组的NIHSS小于对照组(P=0.032);3个月时替罗非班组预后良好(mRS=0-2)患者的比例高于对照组(P=0.038)。结论尿激酶溶栓治疗脑梗死后立即开始予以替罗非班并不增加颅内外出血事件,并能改善患者的预后。研究表明尿激酶溶栓治疗脑梗死后立即开始予以替罗非班安全、有效。

Objective To investigate the safety and efficacy of urokinase plus tirofiban in the treatment of acute ischemic stroke patients.Methods Fifty patients with acute ischemic stroke were infused intravenously urokinase1 500 000 Uand then were randomized into two groups.25 patients in tirofiban group were infused tirofiban（0.4μg/[kg·min]for 30 min,and then 0.1μg/[kg·min]for 72 h）immediately after urokinase,while 25 patients in the control group received no tirofiban.The incidences of intracranial hemorrhage,systematic bleedings and death during the first 14 days were recorded.The National Institutes of Health Stroke Score at day 14 and modified Rankin scale at3 months were assessed.Results There were no statistical differences in the incidences of symptomatic intracranial hemorrhage,intracranial hemorrhage,systematic bleedings and death during the first 14 days（P 0.05）between the two groups.At day 14 the average National Institutes of Health Stroke Score in tirofiban group was significantly lower than that of control group（7.46 versus 9.48,P =0.032）,and at 3 months more patients had favorable outcomes of modified Rankin scale 0 to 2（2.6 versus 1,P =0.038）.Conclusion Intravenous tirofiban immediately after urokinase can improve outcomes of acute ischemic stroke patients without increasing the events of bleedings.It is safe and potentially more effective when compared with urokinase alone for acute stroke patients.