中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (8): 740-745. doi: 10.3969/j.issn.1672-6731.2020.08.015

• 临床研究 • 上一篇    下一篇

2 替罗非班在超时间窗非大血管闭塞性缺血性卒中中的应用价值

周星辰, 束汉生, 王大巍, 张辉, 王昊, 杨光, 闵敬亮   

  1. 233000 蚌埠医学院第二附属医院神经外科
  • 收稿日期:2020-07-21 出版日期:2020-08-25 发布日期:2020-09-21
  • 通讯作者: 束汉生,Email:shuhansheng1968@163.com
  • 基金资助:

    蚌埠医学院科研课题（项目编号：BYKY18143）

The value of tirofiban in non-macrovascular occlusive ischemic stroke beyond time window

ZHOU Xing-chen, SHU Han-sheng, WANG Da-wei, ZHANG Hui, WANG Hao, YANG Guang, MIN Jing-liang   

  1. Department of Neurosurgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
  • Received:2020-07-21 Online:2020-08-25 Published:2020-09-21
  • Supported by:

    This study was supported by Research Project of Bengbu Medical College (No. BYKY18143).

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摘要：

目的 探讨超时间窗非大血管闭塞性缺血性卒中患者早期应用替罗非班的临床价值。方法 对2017年4月至2019年4月的90例超时间窗非大血管闭塞性缺血性卒中患者临床资料进行回顾分析，根据不同治疗方案分为替罗非班联合双联抗血小板治疗组（治疗组，50例）和单纯双联抗血小板治疗组（对照组，40例）；于治疗第1、3和7天进行神经功能缺损程度[美国国立卫生研究院卒中量表（NIHSS）]评价，入院当日与治疗3个月后进行神经功能恢复[改良Rankin量表（mRS）]和日常生活活动能力[日常生活活动能力量表（ADL）]评价，并记录两组患者治疗期间出血及严重血小板减少事件（血小板计数< 100×109/L）的发生情况。结果 治疗后不同时间点两组NIHSS评分差异具有统计学意义（P=0.000）。对照组治疗第7天时，NIHSS评分低于第1天（P=0.000）和第3天（P=0.000）；治疗组治疗后第1、3和7天NIHSS评分呈逐渐下降趋势（均P=0.000），且明显低于对照组（P=0.000）。两组治疗3个月后，mRS评分（P=0.000）低于、ADL评分高于（P=0.000）治疗前，且治疗组mRS评分低于（P=0.000）、ADL评分高于（P=0.003）对照组。治疗组与对照组患者出血及严重血小板减少事件发生率差异无统计学意义[26%（13/50）对35%（14/40）；χ2=0.483，P=0.439]。结论 对于超时间窗非大血管闭塞性缺血性卒中患者，发病早期静脉应用替罗非班能够显著改善其神经功能，提高生活质量和日常生活活动能力。

关键词: 卒中, 脑缺血, 血小板聚集抑制剂

Abstract:

Objective To observe the clinical value of early application of tirofiban in patients with non-macrovascular occlusive ischemic stroke beyond time window. Methods Clinical data of 90 patients with non-macrovascular occlusive ischemic stroke treated beyond time window from April 2017 to April 2019 were retrospectively analyzed. According to different treatment, they were divided into 2 groups, one group given tirofiban combined with double antibody treatment (treatment group, 50 cases) and another group given double antibody treatment only (control group, 40 cases). National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological status of patients on the 1st, 3rd and 7th day of treatment. On the day of admission and 3 months after treatment, modified Rankin Scale (mRS) and Activities of Daily Living Scale (ADL) were used to evaluate the neurological recovery and activities of daily living. The occurrence of bleeding and severe thrombocytopenia (platelet count < 100×109/L) during the treatment was also recorded in 2 groups. Results Differences in NIHSS scores between 2 groups at different time points after treatment were statistically significant (P=0.000). On the 7th day of treatment in the control group, the NIHSS scores were lower than those on the 1st day (P=0.000) and on the 3rd day (P=0.000), which suggested that the degree of neurological deficits had improved. The NIHSS scores on the 1st, 3rd and 7th day after treatment showed a gradual downward trend (P=0.000, for all), and was significantly lower than the control group (P=0.000). After 3 months of treatment in 2 groups, the mRS score was lower than that before treatment (P=0.000), while the ADL score was higher than that before treatment (P=0.000). The mRS score in the treatment group was lower than control group (P=0.000), and the ADL score was higher than control group (P=0.003). There was no significant difference in the incidence of bleeding and severe thrombocytopenia between the treatment group and the control group[26% (13/50) vs. 35% (14/40); χ2=0.483, P=0.439]. Conclusions The early application of tirofiban in patients with non-macrovascular occlusive ischemic stroke beyond time window can significantly improve the patient's neurological function, improve the quality of life and activities of daily living.

Key words: Stroke, Brain ischemia, Platelet aggregation inhibitors

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