替罗非班序贯双抗治疗超时间窗急性缺血性脑卒中的临床疗效

Clinical efficacy of tirofiban sequential dual-antibody therapy for acute ischemic stroke in the ultra-time window

目的探究替罗非班治疗急性缺血性脑卒中(AIS)的临床疗效。方法回顾性选取2020年1月-2023年6月东莞市大朗医院神经内科诊治首次发病>6小时250例的AIS患者为研究对象,随机分为对照组与研究组,每组各125例。对照组给予双联抗血小板治疗(DAPT),研究组先给予替罗非班后序贯DAPT,比较两组治疗前、治疗后神经功能损伤情况、日常生活能力改善情况及磁共振DWI结果;同时随访3个月,比较两组预后情况。结果治疗24h、3d、7d后,研究组神经功能损伤(NIHSS)评分明显低于对照组(P<0.05),30d后Barthel指数评价日常生活能力(ADL)评分明显高于对照组(P<0.05),90d后mRS评分均明显低于对照组(P<0.05);磁共振DWI结果显示,研究组有效率明显高于对照组(86.40%vs.73.60%,P=0.02);两组出血情况的发生率比较,差异无统计学意义(P>0.05)。结论替罗非班序贯DAPT能有效减轻AIS患者的神经功能损伤,预防血栓再形成,改善其远期疗效,安全性较高。

Objective To investigate the clinical effect of tirofiban treatment for acute ischemic stroke(AIS).Methods Retrospective selection of AIS patients diagnosed and treated in the neurology department of our hospital from January 2020 to June 2023 with the first onset>6 hours as the research subjects.A total of 250 patients were collected and randomly divided into a control group and a study group,with 125 cases in each group.The control group was given dual antiplatelet therapy(DAPT),and the study group was given tirofiban followed by sequential DAPT.The neurological injury,improvement of daily living ability and magnetic resonance DWI results of the two groups were compared between the two groups before and after treatment.At the same time,the two groups were followed up for 3 months to compare the prognosis.Results After 24 hours,3 days and 7 days of treatment,the neurological impairment(NIHSS)score of the study group was significantly lower than that of the control group(P<0.05),the Barthel index evaluation of ability to perform activities of daily living(ADL)score was significantly higher than that of the control group after 30d(P<0.05),and the mRS scores were all significantly lower than that of the control group after 90d(P<0.05).The results of magnetic resonance DWI showed that the effective rate of the study group was significantly higher than that of the control group(86.40%vs.73.60%,P=0.02);the difference in the incidence of bleeding between the two groups was not statistically significant(P>0.05).Conclusion The administration of tirofiban sequential DAPT to patients with AIS can effectively reduce the neurological impairment of the patients,prevent the re-formation of thrombosis,and improve their longterm therapeutic efficacy,with its high safety.