替罗非班在穿支动脉硬化性脑梗死静脉溶栓后的应用效果及对神经功能的影响

Effect of tirofiban on intravenous thrombolysis in perforator arteriosclerotic cerebral infarction and its effect on nerve function

目的 探讨替罗非班在穿支动脉硬化性脑梗死静脉溶栓后的应用效果及对患者神经功能的影响。方法 前瞻性选择2022年2月至2023年12月濮阳油田总医院收治的100例穿支动脉硬化性脑梗死患者作为研究对象,采用随机数表法分为对照组和研究组各50例。两组患者均给予基础治疗,对照组患者采取阿司匹林和氯吡格雷治疗,研究组患者采取替罗非班治疗,两组患者的疗程为3周。治疗3周后,比较两组患者的临床效果,以及治疗前、治疗3周后的血管内皮功能指标[血小板衍生内皮细胞生长因子(PD-ECGF)、血小板内皮细胞黏附分子1(PECAM-1)、血管细胞黏附分子1 (VCAM-1)、细胞间黏附分子1 (ICAM-1)]、神经功能指标[美国国立卫生研究院卒中量表评分(NIHSS)、简易精神状态检查量表(MMSE)评分];同时比较两组患者治疗期间的不良反应发生情况。结果 研究组患者的治疗总有效率为96.00%,明显高于对照组的84.00%,差异有统计学意义(P<0.05);研究组患者治疗3周后的血清PD-ECGF、PECAM-1、VCAM-1、ICAM-1水平分别为(625.75±45.10) ng/m L、(601.14±40.35) ng/m L、(662.36±40.20) ng/mL、(313.74±20.25) ng/mL,明显低于对照组的(712.22±50.18) ng/mL、(771.71±50.33) ng/mL、(872.02±50.28) ng/m L、(482.80±30.30) ng/m L,差异均有统计学意义(P<0.05);研究组患者治疗3周后的NIHSS评分为(6.37±2.00)分,明显低于对照组的(13.12±2.15)分,MMSE评分为(24.55±4.02)分,明显高于对照组的(21.62±2.41)分,差异均有统计学意义(P<0.05);治疗期间,研究组患者的不良反应总发生率为10.91%,略高于对照组的9.09%,但差异无统计学意义(P>0.05)。结论 替罗非班在穿支动脉硬化性脑梗死静脉溶栓后的临床应用能改善患者的血管内皮细胞功能,提高神经功能,临床应用效果显著,且安全性较高。

Objective To investigate the effect of tirofiban on intravenous thrombolysis in perforator arteriosclerotic cerebral infarction and its effect on nerve function.Methods A total of 100 patients with perforator arteriosclerotic cerebral infarction admitted to Puyang Oilfield General Hospital from February 2022 to December 2023 were prospectively selected.They were randomly divided into a control group and a study group using a random number table method,with 50 patients in each group.Based on basic treatment,patients in the control group were treated with aspirin and clopidogrel,while those in the study group were treated with tirofiban,all for 3 weeks.After treatment,the clinical outcomes of the two groups were compared,as well as the vascular endothelial function indicators(platelet-derived endothelial cell growth factor,PD-ECGF;platelet endothelial cell adhesion molecule-1,PECAM-1;vascular cell adhesion molecule-1, VCAM-1;intercellular cell adhesion molecule-1, ICAM-1) and neurological function indicators (National Institutes of Health Stroke Scale, NIHSS;Mini-mental State Examination, MMSE) before and after 3 weeks of treat-ment. The occurrence of adverse reactions during the treatment in the two groups were recorded. Results The total ef-fective rate in the study group after treatment was 96.00% , which was significantly higher than 84.00% in the control group (P<0.05). The serum levels of PD-ECGF, PECAM-1, VCAM-1, and ICAM-1 in the study group after 3 weeks of treatment were (625.75±45.10) ng/mL, (601.14±40.35) ng/mL, (662.36±40.20) ng/mL, and (313.74±20.25) ng/mL, re-spectively, which were significantly lower than (712.22±50.18) ng/mL, (771.71±50.33) ng/mL, (872.02±0.28) ng/mL, and (482.80±30.30) ng/mL in the control group (P<0.05). The NIHSS score of the study group after 3 weeks of treat-ment was (6.37±2.00) points, significantly lower than (13.12±2.15) points in the control group, and the MMSE score was (24.55±4.02) points, significantly higher than (21.62±2.41) points in the control group, with statistically significant dif-ferences (P<0.05). During the treatment period, the total incidence of adverse reactions in the study group was 10.91%, slightly higher than 9.09% in the control group (P>0.05). Conclusion The clinical application of tirofiban after intrave-nous thrombolysis in perforator arteriosclerotic cerebral infarction can improve the patients’vascular endothelial cell function and neurological function, and results in significant clinical efficacy and high safety.