替罗非班治疗进展性脑卒中的疗效研究  

The Research of Tirofiban in Treating Progressing Stroke

作　　者：吕宪民[1] 陈丽丽[1] 曹亦宾[1] 安雅臣[2] 王海英[1] 吕艳华[1] 佟旭[1] 

机构地区：[1]河北省唐山市工人医院神经内科二病区,063000 [2]华北煤炭医学院附属医院神经内科

出　　处：《中国全科医学》2010年第30期3376-3377,3380,共3页Chinese General Practice

摘　　要：目的探讨替罗非班联合小剂量肝素对进展性脑卒中治疗的有效性和安全性。方法将2009年1月—2010年1月在我院神经内科住院的急性脑卒中患者作为研究对象,将美国国立卫生研究院卒中量表(NIHSS)评分增加1分定义为进展性脑卒中,共30例患者符合进展性脑卒中诊断标准,对入选患者进行TOAST分型及OCSP分型并随机分为治疗组和对照组。治疗组除常规治疗外,停用所有抗血栓药物,给予肝素钠+替罗非班持续泵入;对照组单独应用肝素持续静脉泵入;采用NIHSS在患者入院时、进展时及治疗后24h、48h、72h、7d时进行神经功能缺失评价;在治疗后90d,采用改良Rankin量表(mRS)对患者进行预后评定。详细记录用药及随诊期间患者的出血部位及死亡原因。结果入院时及进展时两组患者的NIHSS评分间差异无统计学意义(P>0.05)。治疗48h、72h及7d时两组患者的NIHSS评分比较,差异均有统计学意义(P<0.05)。治疗后90d时随访,两组患者的mRS评定结果间差异无统计学意义(P>0.05)。两组患者90d内出血率、死亡率比较,差异亦均无统计学意义(P>0.05)。结论替罗非班联合小剂量肝素能够明显改善急性进展性脑卒中患者神经功能缺失,改善患者预后,且不增加出血率和死亡率。Objective To search the efficacy and safety of tirofiban and minor heparin in treating progressing stroke.Methods The patients who diagnosed with acute stroke and hospitalized in our department from January 2009 to January 2010 were enrolled.The progressive stroke defined as a increase ≥1 point in National Institutes of Health Stroke Scale （NIHSS）,and a total of 30 patients meet the criteria of progressive stroke and they were divided into treatment and control group randomly.TOAST and OCSP classification were performed for every patient.The treatment group was not given antithrombotics but only conventional treatment,and was infused continuously with heparin sodium and tirofiban;the control group was infused with heparin alone.NIHSS was used to evaluate the patients＇ neurologic deficit at the time of admission,progress and 24th,48th,72th hour and 7th day after treatment.We also performed Modified Rankin Scale for patients at the time of 90 days after treatment.The use of medicine,organ of bleeding and the causes of death during treatment were recorded in detail.Results The difference of the score of NIHSS between the two groups at the time of admission and progress was not significant（P0.05）.48 h,72 h and 7d after treatment,the difference of the score of NIHSS between the two groups was significant（P0.05）.Follow-up survey after 90d showed that the difference of mRS was not significant（P0.05）.The difference of bleeding rate and mortality rate during the 90d was also not significant（P0.05）.Conclusion Tirofiban combined with low dose heparin therapy can improve neurological deficits of stroke patients with acute progressive,and can improve patients＇ prognosis without increasing bleeding rate and mortality rate.

关 键 词：急性脑卒中 进展 替罗非班 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]