替罗非班桥接双联抗血小板治疗急性脑梗死临床观察  

Clinical observation of tirofiban bridged with aspirin and clopidogrel dual antiplatelet in the treatment of acute cerebral infarction

作　　者：骆志坚[1] 闵杰[1] LUO Zhijian;MIN Jie(Department of Neurology Stroke Unit,First Affiliated Hospital of Yangtze University,Jingzhou 434000,China)

机构地区：[1]长江大学附属第一医院神经内科重症监护室

出　　处：《中国实用神经疾病杂志》2019年第15期1656-1661,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的观察早期使用替罗非班桥接拜阿司匹林和氯吡格雷双联抗血小板治疗急性脑梗死的疗效,并评价其安全性。方法回顾性连续纳入2017-10—2018-08长江大学附属第一医院神经内科确诊的128例急性脑梗死患者,依据发病24 h内是否使用替罗非班治疗分为替罗非班组和对照组,共68例纳入替罗非班组,先静脉泵入替罗非班治疗48 h,后过渡为拜阿司匹林和氯吡格雷双联治疗2周。对照组60例仅接受拜阿司匹林和氯吡格雷治疗。2组在治疗第1、3和15天进行美国国立卫生研究院卒中量表(NIHSS)评分和日常生活活动能力量表(ADL)评分,记录2周内颅内出血(包括脑实质出血和脑出血转化)、全身性出血和3个月内死亡发生率。3个月后评估改良的Rankin量表(mRS)评分。根据治疗后3个月mRS评分,将mRS≤2分为预后良好,3≤mRS≤6分为预后不良。结果2组2周内颅内出血、全身性出血和3个月内病死率差异均无统计学意义(P值分别为0.929、0.827、0.929);治疗第3和15天,替罗非班组NIHSS评分较对照组显著降低(P值分别为0.042和0.016),ADL评分明显升高(P值分别为0.035和0.018)。3个月后,替罗非班组mRS 0~2的比例显著高于对照组(50%vs 31.6%,P=0.027)。结论早期静脉应用替罗非班桥接拜阿司匹林和氯吡格雷双联抗血小板是一种安全、有效的治疗急性脑梗死的方法。Objective To observe the efficacy of tirofiban bridged with aspirin and clopidogrel dual antiplatelet therapy in the early stage treatment of acute cerebral infarction,and evaluate the safety.Methods 128 hospitalized cases suffering from acute cerebral infarction diagnosed by the Department of Neurology,First Affiliated Hospital of Yangtze University,from October 2017 to August 2018,were studied retrospectively.The patients were divided into tirofiban group and control group according to whether they had been used tirofiban or not within 24 hours of onset.Tirofiban group included 68 patients,who were pumped with tirofiban for the first 48h,and then aspirin and clopidogrel dual antiplatelet therapy for the next 2 weeks.Control group included 60 patients,who only received the treatment of aspirin and clopidogrel.For the both 2 groups,made a recorder on their National Institutes of Health Stroke Scale(NIHSS)scores,Activities of daily living(ADL)scores as well as the incidence of intracranial hemorrhage,systemic bleeding within 2 weeks,mortality within 3 months.Made an evaluation on the improved Rankin Scale(mRS)after 3 months.The mRS≤2 was considered as a good prognosis,3≤mRS≤6 points was a poor prognosis.Results There were no significant between-group differences in the incidence of intracranial hemorrhage,systemic bleeding within 2 weeks,mortality within 3 months(P value was 0.929,0.827,0.929,respectively).Tirofiban group has a significantly lower NIHSS score(P value was 0.042 and 0.016),a markedly elevated ADL score(P value was 0.035 and 0.018),compared with control group on the 3d and 15d.The proportion of 0≤mRS≤2 in tirofiban group was significantly higher than that of control group after 3 months(50%vs 31.6%;P=0.027).Conclusion Tirofiban bridged with aspirin and clopidogrel dual antiplatelet therapy in the early stage treatment of acute cerebral infarction is safe and effective.

关 键 词：替罗非班 脑梗死 急性期 阿司匹林 氯吡格雷 有效性 安全性 

分 类 号：R743.33[医药卫生—神经病学与精神病学]