摘要
目的:分析致残性急性缺血性小卒中在阿替普酶(alteplase,rt-PA)静脉溶栓治疗后早期静脉使用替罗非班(tirofiban)抗血小板治疗的安全性和有效性。方法:本研究为回顾性研究,通过多模影像连续入取了2011年1月至2018年6月陆军军医大学第三附属医院神经内科的小血管病变或大动脉粥样硬化型,且入院时NIHSS评分≤5分和发病在4.5 h内的致残性急性缺血性小卒中病例(n=80)。根据静脉溶栓治疗后早期是否静脉使用替罗非班抗血小板治疗分为标准治疗组(n=37)和静脉溶栓治疗后早期使用替罗非班治疗组(n=43);分析治疗后24 h、48 h、7 d或出院时的美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分变化值、临床症状恶化率(进展和复发)、颅内及其他部位出血的发生率、死亡率、90 d后的改良Rankin量表(modified Rankin scale,mRs)评分。结果:2组在性别构成、年龄分布、基础疾病史、溶栓前NIHSS评分、责任血管的构成比、血压、血糖、血脂、院前使用抗血小板药物等基线情况比较差异无统计学意义(P>0.05);早期使用静脉替罗非班治疗组NIHSS评分下降程度有低于阿替普酶静脉标准治疗组的趋势,但2组在治疗后24 h NIHSS评分变化值差异无统计学意义(2vs. 2,P=0.519)、48 h NIHSS评分变化值差异无统计学意义(2 vs. 2,P=0.265)、7 d NIHSS评分变化值差异无统计学意义(3 vs.3,P=0.162);早期静脉使用替罗非班治疗组临床症状恶化率低于阿替普酶静脉标准治疗组(4.7%vs. 18.9%,P<0.05);2组在出血发生率和死亡率为0,2组90 d后的mRs评分差异无统计学意义(P>0.05)。结论:致残性急性缺血性小卒中静脉溶栓后早期静脉使用替罗非班抗血小板治疗是安全和可能更有效的。
Objective:To analyze the safety and efficacy of early intravenous antiplatelet therapy with tirofiban after intravenous thrombolysis with alteplase in patients with disability-causing acute ischemic minor stroke. Methods:Clinical data were successively collected using multimode image and also retrospectively analyzed regarding 80 minor stroke patients with small vascular lesions or large artery atherosclerosis. These patients with disability-causing acute ischemic minor stroke were admitted to the Department of Neurology at the Third Affiliated Hospital of Army Medical University from January 2011 to June 2018,each case on admission with a National Institutes of Health Stroke Scale(NIHSS)score of ≤5 and an onset time of <4.5 hours. According to whether tirofiban antiplatelet therapy was intravenously used in the early stage after intravenous thrombolysis,these patients were divided into standard treatment group(n=37)and early intravenous tirofiban treatment group(n=43). The changes in NIHSS score were evaluated at 24 h,48 h,and day 7 of treatment or at discharge. In addition,the rate of deterioration of clinical symptoms(progression and recurrence),incidence rate of intracranial and other hemorrhages,mortality,and modified Rankin scale(m RS)score after 90 days were analyzed.Results:There were no significant differences between these two groups regarding their baseline data,including sex composition,age distribution,history of underlying diseases,NIHSS score before thrombolysis,constituent ratio of offending vessels,blood pressure,blood glucose,blood lipids,and pre-hospital use of antiplatelet drugs. The early intravenous tirofiban treatment group had a more reduction in NIHSS score than the standard treatment group,but there were no significant differences in NIHSS score between these two groups at 24 hours(NIHSS=2 vs. NIHSS=2,P=0.519),48 hours(NIHSS=2 vs. NIHSS=2,P=0.265),and day 7(NIHSS=3 vs. NIHSS=3,P=0.162)of treatment. The early intravenous tirofiban treatment group had a significantly lower rate of deteri
作者
王欢
颜晓敏
陈英
赖小华
周杨
Wang Huan;Yan Xiaomin;Chen Ying;Lai Xiaohua;Zhou Yang(Department of Neurology,The First Affiliated Hospital of Chongqing Medical University)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2020年第1期126-129,共4页
Journal of Chongqing Medical University
关键词
急性脑梗死
静脉溶栓
替罗非班
致残性小卒中
acute cerebral infarction
intravenous thrombolysis
tirofiban
disablity-causing minor stroke
