动静脉联合灌注替罗非班在非大血管闭塞急性缺血性脑卒中患者中的应用

The application of intravenous and intra-arterial combined perfusion of tirofiban in treating acute ischemic stroke patients with no large vessel occlusion

目的探讨动静脉联合灌注替罗非班治疗非大血管闭塞急性急性缺血性脑卒中(AIS)患者的价值。方法回顾性分析2017年3月1日至2018年5月1日收治的非大血管闭塞AIS患者34例。根据是否行急症脑血管造影和替罗非班治疗,分为研究组(15例)和对照组(19例)。两组患者入院前、治疗后24 h、治疗后7 d评估美国国立卫生研究院卒中量表(NIHSS)评分,治疗后90 d评估改良Rankin量表(mRS)评分。结果两组患者治疗后均无脑出血发生,无药物不良反应。研究组1例出现腹股沟穿刺点皮下瘀血,对症处理1个月后基本吸收。研究组患者治疗后NIHSS评分显著低于治疗前(P<0.05);7 d NIHSS评分显著低于对照组(P<0.05);90 d mRS评分≤2患者比例显著高于对照组(P<0.05)。结论对于急症脑血管造影排除大血管闭塞的AIS患者,动静脉联合灌注替罗非班是一种安全有效的治疗方法。

Objective To discuss the application of intravenous and intra-arterial combined perfusion of tirofiban in treating acute ischemic stroke(AIS)patients with no large vessel occlusion.Methods The clinical data of a total of 34 AIS patients with no large vessel occlusion,who were admitted to authors’hospital during the period from March 1,2017 to May 1,2018,were retrospectively analyzed.According to whether emergency cerebral angiography and tirofiban therapy were adopted,the patients were divided into the study group(n=15)and the control group(n=19).National Institutes of Health Stroke Scale(NIHSS)score was used to evaluate the curative effects in all patients of both groups before admission,as well as at 24 hours and at 7 days after treatment.Modified Rankin Scale(mRS)score was used to assess the curative effect at 90 days after the treatment.Results After treatment,no intracerebral hemorrhage or drug adverse reaction occurred in both groups.In the study group,one patient developed subcutaneous congestion of inguinal puncture site,which was basically absorbed after symptomatic treatment in one month.In the study group,the postoperative NIHSS score was remarkably lower than the preoperative one(P<0.05),the 7-day postoperative NIHSS score was significantly lower than that in the control group(P<0.05),and the proportion of patients with 90-day mRS score≤2 was obviously higher than that in the control group(P<0.05).Conclusion For AIS patients,in whom large vessel occlusion has been excluded by emergency cerebral angiography,intravenous and intraarterial combined perfusion of tirofiban is a safe and effective therapy.