替罗非班联合阿替普酶对超早期脑梗死患者缺血半暗带的影响

Effects of tirofiban combined with alteplase on ischemic penumbra in patients with ultra-early cerebral infarction

目的探究替罗非班联合阿替普酶对超早期脑梗死患者缺血半暗带的影响。方法回顾性分析2016-04—2018-08焦作市人民医院收治96例超早期脑梗死患者,随机分为观察组(n=50)和对照组(n=46),对照组采用阿替普酶静脉注射治疗,观察组在对照组基础上给予替罗非班治疗。比较2组患者治疗后临床疗效、治疗前后缺血半暗带(IP)相对弥散系数(rADC)、缺血低灌注区及缺血中心区面积,治疗后缺血半暗带存在比率。结果观察组治疗后总有效率(96%)高于对照组(89.13%),2组对比差异无统计学意义(P>0.05)。治疗前后2组缺血半暗带rADC值均为由内向外逐渐变大,且所选四点rADC值治疗前后差异显著(P<0.05);2组4个点治疗后rADC值均显著高于治疗前(P<0.05),且观察组增大水平显著高于对照组(P<0.05)。治疗后2组缺血低灌注面积较治疗前显著减小,且观察组减小幅度显著高于对照组(P<0.05);2组治疗后缺血中心区面积较治疗前明显扩大,而观察组扩大幅度明显小于对照组(P<0.05)。治疗后存在缺血半暗带比率观察组(90.46%)显著高于对照组(60.47%)(P<0.05)。结论替罗非班联合阿替普酶治疗超早期脑梗死疗效明显,可显著减少缺血半暗带,修复脑组织,拯救超早期脑梗死患者生命。

Objective To investigate the effects of tirofiban combined with alteplase on ischemic penumbra(IP)in patients with ultra-early cerebral infarction.Methods Data of 96 patients with ultra-early cerebral infarction who were admitted and treated in the hospital during the period from April 2016 to August 2017 were retrospectively analyzed.According to the treatment method,they were divided into the observation group(n=50)and the control group(n=46).The control group was treated with intravenous injection of alteplase,and the observation group was treated with tirofiban based on the treatment of control group.The clinical effect after treatment,IP and relative apparent diffusion coefficient(rADC)before and after treatment,areas of ischemic hypoperfusion region and ischemic central region,and the ratio of ischemic penumbra after treatment were compared between the 2 groups.Results The total response rate of the observation group(96%)was higher than that of the control group(89.13%)(P>0.05).The rADC values of IP in the 2 groups were gradually increased from the inside to the outside,and there were significant differences in rADC values at the four sites selected before and after treatment(P<0.05).The rADC values of the 2 groups were significantly increased after treatment(P<0.05),and the increase was significantly greater in the observation group(P<0.05).The ischemic hypoperfusion areas in the 2 groups were significantly reduced after treatment,and the reduction was significantly greater in the observation group(P<0.05).The ischemic central area was significantly increased after treatment,and the increase was significantly smaller in the observation group than the control group(P<0.05).The ratio of IP was significantly higher in the observation group(90.46%)than in the control group(60.47%)(P<0.05).Conclusion Tirofiban combined with alteplase is effective in the treatment of ultra-early cerebral infarction.It can significantly reduce IP,repair brain tissues and save the lives of patients with ultra-early cerebral infarction.