经动脉导管局部替罗非班给药对超时间窗急性脑卒中患者脑血流动力学及神经功能损伤的影响

Effects of local administration of tirofiban via arterial catheter on cerebral hemodynamics and nerve function damage in patients with acute stroke beyond time window

目的探讨经动脉导管局部替罗非班给药对超时间窗急性脑卒中患者脑血流动力学及神经功能损伤的影响。方法选取2018年3月至2021年3月在陕西省核工业二一五医院就诊的急性缺血性脑卒中(超出溶栓时间窗)患者72例,采用随机数表法分为观察组与对照组各36例。对照组患者给予强化抗血小板聚集药物联合降脂药物治疗,观察组在对照组治疗的基础上采用经动脉导管局部替罗非班给药治疗,两组疗程均为两周。治疗结束后,比较两组患者的临床疗效、治疗前及治疗2~24 h及两周后的神经功能缺损评分(NIHSS);比较两组患者治疗前及治疗两周后的肢体运动功能评分(FMA)和日常生活活动能力[Barthel指数(BI)评定量表];采用经颅多普勒超声检测并比较两组患者治疗前及治疗两周后的基底动脉和双侧大脑中动脉血流情况;比较两组患者治疗期间不良反应发生情况。结果治疗两周后观察组患者的临床治疗总有效率为91.67%,明显高于对照组的72.22%,差异有统计学意义(P<0.05);治疗后各时间点,两组患者的NIHSS评分均明显降低,且观察组患者各时间点的评分明显低于对照组,差异均有统计学意义(P<0.05);治疗两周后,两组患者的FMA评分和BI评分均明显升高,脑血流速度均明显加快,且观察组患者的FMA评分和BI评分明显高于对照组,基底动脉、左侧大脑中动脉、右侧大脑中动脉脑血流速度快于对照组,差异均有统计学意义(P<0.05);两组患者治疗期间不良反应发生率比较差异无统计学意义(P>0.05)。结论经动脉导管局部替罗非班给药能够显著改善超时间窗急性缺血性脑卒中患者的脑血流速度和神经功能损伤,缓解患者肢体运动功能障碍,提高患者日常生活活动能力,且不会增加严重全身性出血不良反应。

Objective To explore the effects of local administration of tirofiban via arterial catheter on cerebral hemodynamics and nerve function damage in patients with acute stroke beyond time window.Methods A total of 72patients with acute ischemic stroke beyond thrombolysis time window treated in the 215;Hospital of Shaanxi Nuclear Industry were enrolled between March 2018 and March 2021.According to random number table method,they were divided into an observation group and a control group,with 36 cases in each group.The control group was treated with intensive ant-iplatelet aggregation drugs and lipid-lowering drugs,while the observation group was given local administration of tirofiban via arterial catheter on basis of control group.All the patients were treated for 2 weeks.After treatment,clinical curative effect,scores of National Institute of Health Stroke Scale(NIHSS)before treatment,at 2 h,24 h and 2 weeks after treatment,and scores of Fugl-Meyer Assessment(FMA),and Daily living activities score Barthel Index(BI)before treatment and at 2 weeks after treatment were compared between the two groups.The blood flow of basilar artery and bilateral middle cerebral arteries was detected by transcranial Doppler(TCD)before treatment and at 2 weeks after treatment.The occurrence of adverse reactions during treatment between the two groups was compared.Results At 2 weeks after treatment,total response rate of clinical treatment in the observation group was significantly higher than that in the control group(91.67%vs 72.22%,P<0.05).After treatment,NIHSS scores in both groups were significantly decreased,and the scores at different time points after treatment were significantly lower in observation group than in the control group(P<0.05).At 2 weeks after treatment,FMA and BI scores were significantly increased,and cerebral blood flow velocity was significantly accelerated in both groups;FMA and BI scores in the observation group were significantly higher than those in the control group;cerebral blood flow velocity of basilar artery,left middle cerebral artery,and right middle cerebral artery were faster than that in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion Local administration of tirofiban via arterial catheter can significantly improve cerebral blood flow velocity and nerve function damage in patients with acute ischemic stroke beyond time window,relieve motor dysfunction of limbs and improve activities of daily living,without increasing adverse reactions such as severe systemic bleeding.