替罗非班联合机械支架取栓在急性缺血性脑卒中患者中的疗效

Efficacy of tirofiban combined with mechanical stent thrombectomy in patients with acute ischemic stroke

目的探讨替罗非班联合机械支架取栓对急性缺血性脑卒中患者血管再通情况和血浆黏度的影响。方法前瞻性选取榆林市星元医院2021年6月至2023年6月收治的106例急性缺血性脑卒中患者为研究对象,通过随机数字表法分为对照组和观察组各53例。对照组男29例,女24例,年龄(62.38±7.24)岁,病程(2.54±0.56)h,给予机械支架取栓治疗。观察组男27例,女26例,年龄(62.63±7.36)岁,病程(2.48±0.49)h,在机械支架取栓后,静脉泵注替罗非班持续24 h。记录两组患者治疗后的血管再通情况,比较两组治疗前和治疗2周后的凝血功能[凝血酶时间(TT)、凝血酶原时间(PT)、血栓调节蛋白(TM)、凝血酶激活纤溶抑制物(TAFI)]、血液流变学、脑血流动力[脑血管外周阻力(CVR)、平均血流量(Qmean)、平均血流速度(Vmean)]、神经营养因子,并评估两组患者治疗前后的神经功能和生活质量。统计学方法采用χ^(2)检验、t检验。结果观察组治疗后总再通率高于对照组[92.45%(49/53)比66.04%(35/53)],差异有统计学意义(χ^(2)=11.24,P<0.05)。观察组治疗后TT和PT、Qmean、Vmean均高于对照组[(17.97±2.61)s比(16.29±2.42)s、(14.81±2.30)s比(12.76±2.24)s、(8.62±0.95)ml/s比(7.74±0.74)ml/s、(19.51±2.84)cm/s比(17.08±2.57)cm/s],差异均有统计学意义(t=3.44、4.65、5.32、4.62,均P<0.05);观察组治疗后TM、TAFI、CVR均低于对照组[(14.13±2.01)μg/L比(18.14±2.23)μg/L、(23.16±3.54)mg/L比(40.45±5.97)mg/L、(70.53±7.26)kPa·s/m比(79.32±8.34)kPa·s/m],差异均有统计学意义(t=9.72、18.14、5.79,均P<0.05)。观察组治疗后血液流变学指标均低于对照组,神经营养因子水平均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者治疗后的美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评分均低于对照组[(5.23±1.01)分比(7.10±1.13)分、(1.81±0.35)分比(2.29±0.43)分],脑卒中患者专用生活质量量表(SS-QOL)评分高于对照组[(163.99±24.26)分比(131.52±20.18)分],差异均有统计学意义(t=8.98、6.30、7.49,均P<0.05)。结论机械支架取栓联合替罗非班治疗,有助于提高急性缺血性脑卒中患者取栓后的血管再通率,降低血浆黏度。

Objective To explore the effects of tirofiban combined with mechanical stent thrombectomy on vascular recanalization and plasma viscosity in patients with acute ischemic stroke.Methods A total of 106 patients with acute ischemic stroke admitted to Xingyuan Hospital of Yulin from June 2021 to June 2023 were prospectively selected as the study objects,and were divided into a control group and an observation group with 53 patients in each group by the random number table method.In the control group,there were 29 males and 24 females,aged(62.38±7.24)years,and the course of disease was(2.54±0.56)h.In the observation group,there were 27 males and 26 females,aged(62.63±7.36)years,and the course of disease was(2.48±0.49)h.The control group received mechanical stent thrombectomy;the observation group received intravenous infusion of tirofiban for 24 h after mechanical stent thrombectomy.The vascular recanalization after treatment was recorded in both groups.The coagulation function[thrombin time(TT),prothrombin time(PT),thrombomodulin(TM),and thrombin-activatable fibrinolysis inhibitor(TAFI)],hemorheology,cerebral hemodynamics[cerebral vascular resistance(CVR),mean blood flow(Qmean),and mean blood flow velocity(Vmean)],and neurotrophic factors were compared between the two groups before and 2 weeks after treatment.The neurological function and quality of life were evaluated in both groups before and after treatment.Statistical methods wereχ^(2) test and t test.Results The rate of total vascular recanalization in the observation group after treatment was higher than that in the control group[92.45%(49/53)vs.66.04%(35/53)],with a statistically significant difference(χ^(2)=11.24,P<0.05).After treatment,the TT,PT,Qmean,and Vmean in the observation group were higher than those in the control group[(17.97±2.61)s vs.(16.29±2.42)s,(14.81±2.30)s vs.(12.76±2.24)s,(8.62±0.95)ml/s vs.(7.74±0.74)ml/s,(19.51±2.84)cm/s vs.(17.08±2.57)cm/s],with statistically significant differences(t=3.44,4.65,5.32,and 4.62,all P<0.05).After treatment,the TM,TAFI,and CVR in the observation group were lower than those in the control group[(14.13±2.01)μg/L vs.(18.14±2.23)μg/L,(23.16±3.54)mg/L vs.(40.45±5.97)mg/L,(70.53±7.26)kPa·s/m vs.(79.32±8.34)kPa·s/m],with statistically significant differences(t=9.72,18.14,and 5.79,all P<0.05).After treatment,the hemorheological indexes of the observation group were lower than those of the control group,and the levels of neurotrophic factors were higher than those of the control group,with statistically significant differences(all P<0.05).The scores of National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)in the observation group after treatment were lower than those in the control group[(5.23±1.01)points vs.(7.10±1.13)points,(1.81±0.35)points vs.(2.29±0.43)points],but the score of Stroke-Specific Quality of Life(SS-QOL)was higher than that in the control group[(163.99±24.26)points vs.(131.52±20.18)points],with statistically significant differences(t=8.98,6.30,and 7.49,all P<0.05).Conclusion Mechanical stent thrombectomy combined with tirofiban therapy can improve the vascular revascularization rate and reduce the plasma viscosity in patients with acute ischemic stroke.