动脉内替罗非班治疗在急性前循环脑梗死机械取栓术中的临床研究

Clinical trial of intra-arterial tirofiban during mechanical thrombectomy for acute anterior circulation cerebral infarction

目的观察动脉内替罗非班治疗在急性前循环脑梗死机械取栓术中的应用效果。方法回顾性分析急性前循环脑梗死患者临床资料,按队列法分为对照组和试验组,对照组采用机械取栓治疗;试验组在对照组治疗的基础上,给予替罗非班0.25~0.50 mg,动脉内治疗。比较2组患者的围手术期指标[手术时间、取栓次数、血管再通时间、血管再通率],治疗前和治疗后24 h、7 d美国国立卫生研究院卒中量表(NIHSS)评分,治疗前、治疗后7 d血小板指标[血小板平均分布宽度(PDW)、血小板平均容积(MPV)和血小板压积(PCT)],血流动力学指标[血浆黏度(PV)、全血低切黏度(LWBV)、高切黏度(HWBV)],血清生化指标[高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、血管内皮生长因子(VEGF)],临床疗效和安全性。结果本研究最终纳入92例患者,对照组49例,试验组43例。治疗后,试验组和对照组有效率分别为75.51%(37例/49例)和93.02%(40例/43例),在统计学上差异有统计学意义(P<0.05)。试验组和对照组的手术时间分别为(93.53±9.86)和(91.59±8.36)min,血管再通时间分别为(78.46±9.69)和(77.40±10.32)min,血管再通率分别为93.02%和83.67%,治疗后24 h NIHSS评分分别为(10.32±2.90)和(9.59±2.84)分,在统计学上差异均无统计学意义(均P>0.05)。试验组和对照组治疗后7 d NIHSS评分分别为(3.34±1.25)和(4.12±1.48)分,PDW分别为(12.58±1.81)%和(14.15±1.95)%,MPV分别为(9.16±1.24)和(11.26±1.86)fL,PCT分别为(0.33±0.05)%和(0.29±0.04)%,PV分别为(1.64±0.27)和(1.99±0.24)mPa·s^(-1),LWBV分别为(4.16±0.48)和(5.01±0.49)mPa·s^(-1),HWBV分别为(8.12±0.54)和(9.27±0.68)mPa·s^(-1),血清hs-CRP分别为(3.57±0.45)和(4.48±0.83)mg·L^(-1),TNF-α分别为(20.42±4.55)和(27.34±4.95)ng·L^(-1),VEGF分别为(738.80±52.41)和(664.72±41.68)ng·L^(-1),在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组的并发症发生率分别为8.16%(4例/49例)和4.65%(2例/43例),在统计学上差异无统计学意义(P>0.05)。结论急性前循环脑梗死取栓术中给予动脉内替罗非班治疗后,患者神经功能和预后较好,可能与改善血小板功能、脑组织血流和减轻炎症反应相关。

Objective To observe the application effect of intra-arterial tirofiban during mechanical thrombectomy for acute anterior circulation cerebral infarction.Methods The clinical data of patients with acute anterior circulation cerebral infarction were retrospectively analyzed.According to cohort method,they were divided into control group and treatment group.The control group was treated with mechanical thrombectomy,while the treatment group was additionally given intra-arterial therapy with tirofiban 0.25-0.5 mg on the basis of the control group.The perioperative indicators(surgical time,number of thrombectomy,vascular recanalization time,vascular recanalization rate),National Institutes of Health Stroke Scale(NIHSS)score before treatment and at 24 hours and 7 days after treatment,platelet indicators[mean platelet distribution width(PDW),mean platelet volume(MPV),plateletcrit(PCT)],hemorheological indicators[plasma viscosity(PV),low whole blood viscosity(LWBV),high whole blood viscosity(HWBV)],serum indicators[high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),vascular endothelial growth factor(VECF)] and clinical efficacy were compared,and the safety of the treatment regimen was assessed.Results There were 92 patients were finally included in this study,including 49 cases in control group and 43 cases in treatment group.The effective rates in treatment group and control group were 75.51%(37 cases/49 cases)and 93.02%(40 cases/43 cases),with significant difference(P<0.05).The surgical times in treatment group and control group were(93.53±9.86)and(91.59±8.36)min;the vascular recanalization times were(78.46±9.69)and(77.40±10.32)min;the vascular recanalization rates were 93.02%and 83.67%;the NIHSS scores were(10.32±2.90)and(9.59±2.84)points at 24 hours after treatment,all with no significant difference(all P>0.05).At 7 days after treatment,the NIHSS scores in treatment group and control group were(3.34±1.25)and(4.12±1.48)points;the PDW values were(12.58±1.81)%and(14.15±1.95)%;MPV values were(9.16±1.24)and(11.26±1.86)fL;PCT levels were(0.33±0.05)%and(0.29±0.04)%;PV values were(1.64±0.27)and(1.99±0.24)mPa·s^(-1);LWBV values were(4.16±0.48)and(5.01±0.49)mPa·s-';HWBV values were(8.12±0.54)and(9.27±0.68)mPa·s^(-1);serum hs-CRP levels were(3.57±0.45)and(4.48±0.83)mg·L^(-1);TNF-αlevels were(20.42±4.55)and(27.34±4.95)ng·L^(-1);VECF levels were(738.80±52.41)and(664.72±41.68)ng·L^(-1),all with significant difference(all P<0.05).Incidence rates of adverse drug reactions in treatment group and control group were 8.16%(4 cases/49 cases)and 4.65%(2 cases/43 cases)respectively,with no significant difference(P>0.05).Conclusion Intra-arterial tirofiban therapy during thrombectomy for acute anterior circulation cerebral infarction has good neurological function and prognosis,and it may be related to the improvement of platelet function and cerebral tissue blood flow and relief of inflammatory response.