替罗非班治疗缺血性进展性脑卒中临床对照观察

Clinical observation of tirofiban in the treatment of ischemic progressive stroke

目的探讨短期使用替罗非班治疗缺血性进展性脑卒中的临床疗效及安全性.方法将84例缺血性进展性脑卒中患者按治疗方案不同分为两组,每组42例.在常规及对症治疗的基础上,对照组根据患者病情给予改善循环、营养神经等相关治疗,观察组在此基础上联合替罗非班治疗.观察住院全程,随访3个月.于治疗前后检测患者血小板功能(血小板聚集率、血小板黏附率、CD62 p表达),采用改良Rankin量表及美国国立卫生研究院卒中量表评定患者的神经功能.统计治疗期间出血时间发生率,于治疗前及随访3个月末采用Barthel指数评定患者生活质量.结果治疗后两组血小板聚集率、血小板黏附率、CD62p水平、改良Rankin量表评分及美国国立卫生研究院卒中量表评分均较治疗前显著降低(P<0.01),观察组显著低于对照组(P<0.01).两组均未发生重度出血,治疗期间两组出血事件发生率比较差异无统计学意义(P>0.05).随访3个月末,两组Barthel指数评分较治疗前显著升高(P<0.01),观察组显著高于对照组(P<0.05).结论在常规治疗的基础上,短期使用替罗非班治疗缺血性进展性脑卒中疗效显著,可有效改善患者血小板功能,促进神经功能恢复,提高患者生活质量.

Objective To explore the clinical efficacy and safety of short-term use of tirofiban in the treatment of ischemic progressive stroke.Methods 84 patients with progressive ischemic stroke were divided into two groups according to different treatment schemes,42 cases each.On the basis of routine and symptomatic treatment,the control group was given relevant treatment to improve circulation and nutrient nerve according to the patient's condition,while the observation group was given tirofiban on this basis.The entire course of hospitalization was observed,followed up for 3 months.Before and after treatment,the platelet function(platelet aggregation rate,platelet adhesion rate,CD62p expression)of patients was detected.The neurological function was evaluated by mRS and NIHSS.The incidence of bleeding time during treatment was calculated.The Barthel index was used to assess the quality of life of patients before treatment and at the end of 3 months of follow-up.Results After treatment,platelet aggregation rate,platelet adhesion rate,CD62p expression,mRS and NIHSS scores were significantly lower than those before treatment(P<0.01),and the observation group was significantly lower than the control group(P<0.01).No severe bleeding occurred in either group.There was no significant difference in the incidence of bleeding events between the two groups during treatment(P>0.05).At the end of 3 months of followup,the BI score of the two groups was significantly higher than before treatment(P<0.01),and the observation group was significantly higher than the control group(P<0.05).Conclusions On the basis of conventional treatment,the short-term use of tirofiban in the treatment of ischemic progressive stroke has a significant effect,which can effectively improve patients'platelet function,promote nerve function recovery,and improve patients'quality of life.