动脉泵入替罗非班联合尿激酶静脉溶栓对急性脑梗死患者神经功能和生命质量的影响

Effects of Arterial Pumping Tirofiban Combined with Urokinase Intravenous Thrombolysis on Neurological Function and Quality of Life in Patients with Acute Cerebral Infarction

目的探讨动脉泵入替罗非班联合尿激酶静脉溶栓对急性脑梗死患者神经功能和生命质量的影响。方法选取鞍钢集团总医院神经外科2017年8月至2019年8月收治的急性脑梗死患者33例作为研究对象,入院后均进行尿激酶静脉溶栓治疗,溶栓后按照不同处理方案分为观察组和对照组。观察组行全脑血管造影术,术中未见明确颅内大动脉闭塞,给予替罗非班经导管于责任动脉内缓慢泵入。对照组经MRA证实无颅内大血管闭塞,未应用替罗非班。比较两组患者出血情况、神经功能、生命质量、血栓情况及死亡率。结果对照组术后发生出血概率为16.67%(3/18),观察组术后发生出血概率为13.33%(2/15),差异无统计学意义(P>0.05)。治疗14 d,两组患者美国国立卫生研究院卒中量表(NIHSS)评分降低,且观察组NIHSS评分显著低于对照组,差异有统计学意义(P<0.05);术后3个月,两组患者的脑卒中专用生命质量量表(SS-QOL)升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访3个月,对照组1例患者再次复发,1例患者死亡。结论尿激酶溶栓治疗急性脑梗死后动脉泵入替罗非班治疗安全、有效,能够有效改善患者的神经功能和生命质量。

Objective To investigate the clinical effects of arterial pumping tirofiban combined with intravenous thrombolysis in the treatment of neurological function and quality of life in patients with acute cerebral infarction. Methods A total of 33 patients with acute cerebral infarction treated in Neurosurgery of Angang General Hospital from August 2017 to August 2019 were selected as the research objects and were treated with urokinase intravenous thrombolysis after admission. After thrombolysis, they were divided into a study group and a control group according to different treatment schemes. The study group underwent whole-brain angiography. No intracranial aortic occlusion was found during the operation. Tirofiban was slowly pumped into the guiding catheter. In the control group. No intracranial vascular occlusion was confirmed by intravenous MRA, and tirofiban was not used.The bleeding tendency, neurological function, quality of life, thrombosis and mortality were compared between the 2 groups of patients before and after treatment. Results The probability of bleeding tendency in the control group was 16.67%(3/18), and the probability of bleeding tendency in the study group was 13.33%(2/15). The difference was not statistically significant(P>0.05).After 14 days of treatment, the NIHSS scores of the 2 groups of patients decreased, and the NIHSS scores of the study group were significantly lower than those of the control group, and the difference was statistically significant(P<0.05). After 3 months of operation, the quality of life scores of the 2 groups of patients increased, and the study group was significantly higher than the control group, and the difference was statistically significant(P<0.05). During a follow-up of 3 months, 1 patient in the control group relapsed and 1 patient died. Conclusion Urokinase thrombolysis is safe and effective in the treatment of arterial pumping tirofiban after cerebral infarction, which can better improve the neurological function and quality of life of patients.