阿替普酶静脉溶栓后早期应用替罗非班对脑梗死患者血小板和神经缺损的影响

Effect of early application of tirofiban after alteplase intravenous thrombolysis on platelet and nerve defects in patients with cerebral infarction

目的 探讨阿替普酶(rt-PA)静脉溶栓后早期应用替罗非班对脑梗死(CI)患者血小板和神经缺损的影响。方法 选取周口市第一人民医院2019年1月—2021年1月收治的CI患者76例,全部患者行rt-PA静脉溶栓治疗,以随机数字表法将其分为T组与A组,T组(n=38)在溶栓后早期应用替罗非班治疗,A组(n=38)在溶栓后仅给予常规治疗。记录两组治疗前后血小板功能、血液流变学指标、神经功能缺损和生活能力改善情况,并记录两组随访期内再闭塞及颅内出血发生率。结果 治疗后,两组血小板聚集率、血小板黏附率、最大聚集时间、血浆纤维蛋白原、血浆黏度、低氧诱导因子-1α、半胱氨酸天冬氨酸蛋白酶3及NHISS评分、生活能力评分皆低于治疗前(P<0.05),且T组低于A组[(28.40±2.38)%vs (31.06±2.66)%、(35.28±2.73)%vs (38.94±2.96)%、(152.30±15.48)s vs (164.44±17.06)s、(3.10±0.68)g/L vs (3.87±0.74)g/L、(1.35±0.41)mPa·s vs (1.68±0.44)mPa·s、(753.23±102.83)ng/mL vs (920.74±112.63)ng/mL、(10.62±1.48)ng/mLvs (11.53±1.63)ng/mL、(14.72±4.08)分vs (20.64±4.23)分、(2.43±0.37)分vs (3.10±0.42)分](t=4.594、5.603、3.249、4.723、3.382、6.771、2.548、6.210、7.379,P<0.05);随访期内,T组再闭塞率2.63%低于A组15.79%,差异有统计学意义(χ^(2)=3.934,P<0.05)。T组颅内出血率5.26%与A组10.53%比较,差异无统计学意义(χ^(2)=0.724,P>0.05)。结论 CI患者在rt-PA静脉溶栓后早期应用替罗非班治疗能够促进患者血小板功能恢复、改善血液流变学指标、减轻神经功能缺损、促进患者生活能力提高,也能够降低溶栓后再闭塞风险,且用药后未加重颅内出血风险,有临床应用价值。

Objective To investigate the effect of early application of tirofiban after intravenous thrombolysis with alteplase(rt-PA) on platelet and nerve defects in patients with cerebral infarction(CI).Methods A total of 76 CI patients admitted to our hospital from January 2019 to January 2021 were selected.All patients were treated with rt-PA intravenous thrombolytic therapy.They were divided into T group and A group by random number table, and T group(n=38) Tirofiban was applied early after thrombolysis, and group A(n=38) was given only conventional treatment after thrombolysis.The platelet function, blood rheology index, neurological deficit and improvement of living ability before and after treatment were recorded in the two groups, and the incidence of reocclusion and intracranial hemorrhage during the follow-up period of the two groups were recorded.Results After treatment, the two groups of platelet aggregation rate, platelet adhesion rate, maximum aggregation time, plasma fibrinogen, plasma viscosity, hypoxia inducible factor-1α,caspase 3 and NHISS score, life Ability scores were lower than before treatment(P<0.05),and group T was lower than group A [(28.40±2.38)% vs(31.06±2.66)%,(35.28±2.73)% vs(38.94±2.96)%,(152.30±15.48)s vs(164.44±17.06)s,(3.10±0.68)g/L vs(3.87±0.74)g/L,(1.35±0.41)mPa·s vs(1.68±0.44)mPa·s,(753.23±102.83) ng/mL vs(920.74±112.63) ng/mL,(10.62±1.48) ng/mL vs(11.53±1.63) ng/mL,(14.72±4.08) points vs(20.64±4.23) points,(2.43±0.37) points vs(3.10±0.42) points](t=4.594,5.603,3.249,4.723,3.382,6.771,2.548,6.210,7.379,P<0.05);During the follow-up period, the reocclusion rate of group T was 2.63% lower than Group A was 15.79%,the difference was statistically significant(χ^(2)=3.934,P<0.05).Compared with the intracranial hemorrhage rate of 5.26% in group T and 10.53% in group A,the difference was not statistically significant(χ^(2)=0.724,P>0.05).Conclusion Early application of tirofiban treatment in patients with CI after rt-PA intravenous thrombolysis can promote the recovery of platelet function, improve blood rheology indexes, reduce neurological deficits, promote the improvement of patients’ living ability, and reduce post-thrombolysis.The risk of reocclusion, and the risk of intracranial hemorrhage is not aggravated after the medication, which has clinical application value.