小剂量替罗非班治疗急性缺血性脑卒中溶栓后早期神经功能恶化的效果

Effect of low-dose tirofiban in treatment of early neurological deterioration after thrombolysis in acute ischemic stroke

目的 探讨小剂量替罗非班对急性缺血性脑卒中(Acute Ischemic Stroke,AIS)静脉溶栓(Intravenous Thrombolysis,IVT)后早期神经功能恶化(Early Neurological Deterioration,END)的预防效果及安全性。方法 2017年7月—2019年9月在某院接受阿替普酶静脉溶栓的AIS患者144例,溶栓后1 h复查头颅CT,观察未发现存在颅内出血者根据患者及家属意愿决定是否使用替罗非班抗血小板治疗,据此分为观察组和对照组;比较2组患者基线资料,END、症状性颅内出血(Symptomatic Intracerebral Hemorrhage,sICH)、系统性出血发生率及死亡率;评估2组患者IVT后3个月预后情况。结果 观察组END发生率为7.87%,对照组为20.00%,差异具有统计学意义(χ^(2)=4.576,P=0.032);观察组发生sICH、系统性出血及死亡率与对照组比较差异均无统计学意义(P均>0.05);静脉溶栓后24 h,85.39%(76/89)的观察组患者出现CPI,对照组有70.91%(39/55),差异具有统计学意义(χ^(2)=4.434,P=0.035);观察组有2例出现DFI,对照组有9例出现DFI,差异具有统计学意义(χ^(2)=9.601,P=0.002);静脉溶栓3个月后,观察组预后良好率为70.79%,对照组为52.73%,差异具有统计学意义(χ^(2)=4.805,P=0.028)。结论 静脉溶栓后早期联合小剂量替罗非班治疗AIS是安全有效的,能够显著降低早期神经功能恶化程度,短期预后良好。

Objective To investigate the preventive effect and safety of low-dose tirofiban in early neurological deterioration(END)after acute ischemic stroke(AIS)intravenous thrombolysis(IVT).Methods From July 2017 to September 2019,144 patients with AIS who received intravenous thrombolysis with alteplase in a hospital,and no intracranial hemorrhage was found after re-examination of head CT 1 h after thrombolysis and then decided whether to use tirofiban antiplatelet therapy according to the wishes of patients and their families,which were divided into an observation group and a control group.The baseline data,END,symptomatic intracerebral hemorrhage(sICH),the incidence of systemic bleeding,and mortality were compared between the two groups.The prognoses of patients in both groups at 3 months after IVT were assessed.Results The incidence of END in the observation group was 7.87%and 20.00%in the control group,and the difference was statistically significant(χ^(2)=4.576,P=0.032).There were no significant differences in sICH,systemic bleeding,and mortality between the observation group and the control group(all P>0.05).CPI was present in 85.39%(76/89)of patients in the observation group 24 hours after intravenous thrombolysis,and 70.91%(39/55)in the control group,and the difference between the two groups was statistically significant(χ^(2)=4.434,P=0.035).DFI occurred in 2 cases in the observation group and 9 cases in the control group,and the difference was statistically significant(χ^(2)=9.601,P=0.002).After 3 months of intravenous thrombolysis,the good prognosis rate was 70.79%in the observation group and 52.73%in the control group,and the difference was statistically significant(χ^(2)=4.805,P=0.028).Conclusion The early combination of intravenous thrombolysis combined with low-dose tirofiban in the treatment of AIS is safe and effective,which can significantly reduce the deterioration of early neurological function,and the short-term prognosis is good.