偏瘫型卒中预警综合征的治疗:替罗非班与阿司匹林联合氯吡格雷的比较  

Treatment of hemiplegic stroke warning syndrome:comparison between tirofiban and aspirin combined with clopidogrel

作　　者：刘华坤[1] 王鹏[1] 蔡玉森 郑兴月 赵昊天 周亚飞[1] 高丰 王海洋 初建峰[1] 闫中瑞[1] Liu Huakun;Wang Peng;Cai Yusen;Zheng Xingyue;Zhao Haotian;Zhou Yafei;Gao Feng;Wang Haiyang;Chu Jianfeng;Yan Zhongrui(Department of Neurology,Jining First People's Hospital,Jining 272011,China)

机构地区：[1]济宁市第一人民医院神经内科,272011

出　　处：《国际脑血管病杂志》2021年第6期426-431,共6页International Journal of Cerebrovascular Diseases

基　　金：济宁市重点研发计划项目(2018SMNS010)。

摘　　要：目的:探讨替罗非班治疗偏瘫型卒中预警综合征患者的临床安全性及有效性。方法:回顾性纳入2018年1月至2020年5月期间在济宁市第一人民医院住院但未接受静脉溶栓治疗的偏瘫型卒中预警综合征患者。部分患者急性期持续给予替罗非班静脉滴注至少24 h,然后进行口服抗血小板治疗(替罗非班组);部分患者仅接受阿司匹林+氯吡格雷双重抗血小板治疗(对照组)。主要疗效终点为发病后7 d时瘫痪侧肌力及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分,次要疗效终点为发病后3个月时改良Rankin量表(modified Rankin Scale, mRS)评分,≤2分定义为临床转归良好。安全性终点为患者用药过程中的出血事件。采用多变量 logistic回归分析确定临床转归的独立影响因素。 结果:共纳入30例偏瘫型卒中预警综合征患者,其中替罗非班组19例(63.3%),对照组11例(36.7%)。两组基线临床资料均无统计学差异,在治疗过程中均未出现药物相关出血并发症。替罗非班组发病后7 d时瘫痪侧肌力和NIHSS评分、出院时NIHSS评分以及3个月时临床转归良好率均显著优于对照组,差异具有统计学意义( P均<0.05)。多变量 logistic回归分析显示,在校正开始治疗时NHISS评分后,替罗非班是转归良好的独立保护因素(优势比0.040,95%置信区间0.040~0.449;P=0.009)。 结论:替罗非班急性期治疗偏瘫型卒中预警综合征患者安全有效,能有效阻断病情进展,改善患者转归,且不会增高出血风险。Objective To investigate the clinical safety and efficacy of tirofiban in the treatment of hemiplegic stroke warning syndrome.Methods Patients with hemiplegic stroke warning syndrome admitted to Jining First People's Hospital without receiving intravenous thrombolysis from January 2018 to May 2020 were enrolled retrospectively.Some patients were given tirofiban intravenous infusion for at least 24 h in acute phase,then received oral antiplatelet therapy(tirofiban group);some only received aspirin+clopidogrel dual antiplatelet therapy(control group).The primary endpoint was muscle strength at the paralytic side and National Institutes of Health Stroke Scale(NIHSS)score at day 7 after onset.The secondary endpoint was the modified Rankin Scale(mRS)score at 3 months after onset,and≤2 was defined as good clinical outcome.The safety endpoint was the bleeding events during treatment.Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome.Results A total of 30 patients with hemiplegic stroke warning syndrome were enrolled,including 19(63.3%)in the tirofiban group and 11(36.7%)in the control group.There was no significant difference in baseline clinical data between the two groups,and no drug-related bleeding complications occurred during treatment.The muscle strength at paralytic side and NIHSS score at day 7 after onset,NIHSS score at discharge and good clinical outcome rate at 3 months in the tirofiban group were significantly better than those in the control group,and the differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that tirofiban was an independent protective factor for good outcome after adjusting the NIHSS score at the beginning of treatment(odds ratio 0.040,95%confidence interval 0.040-0.449;P=0.009).Conclusions Tirofiban is safe and effective in the treatment of patients with hemiplegic stroke warning syndrome in acute phase.It can effectively block the progress of the disease,improve the o

关 键 词：脑缺血发作 短暂性 内囊 卒中 脑缺血 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]