替罗非班联合硝普钠经动脉给药在急性前后循环大动脉闭塞性脑梗死治疗中的血管再闭塞预防作用  

Vascular Reocclusion Preventive Effect of Intraarterial Administration of Tirofiban Combined with Sodium Nitroprusside in the Treatment of Acute Anterior and Posterior Circulation Aortic Occlusive Cerebral Infarction

作　　者：于甜甜[1] 齐向征[1] 孔宁[1] YU Tian-tian;QI Xiang-zheng;KONG Ning(Department of Neurology,Jiyuan People's Hospital,Jiyuan 459000,China)

机构地区：[1]济源市人民医院神经内科,济源459000

出　　处：《中国合理用药探索》2021年第11期71-76,共6页Chinese Journal of Rational Drug Use

基　　金：河南省医学科技攻关计划项目(2018020820)。

摘　　要：目的:探讨机械取栓中替罗非班联合硝普钠经动脉给药在急性前后循环大动脉闭塞性脑梗死治疗中的血管再闭塞预防作用。方法:回顾性分析2016年8月~2020年7月进行机械取栓治疗的80例急性前后循环大动脉闭塞性脑梗死患者的临床资料,患者均在机械取栓过程中出现血栓负荷量大而需进行动脉内药物注射治疗,根据机械取栓术中动脉内药物注射情况分为A组(n=43)和B组(n=37)。A组术中动脉内注射替罗非班联合硝普钠,B组术中动脉内注射替罗非班。统计比较两组成功再通率、90天内血管再闭塞的发生率、90天内病变残余狭窄率、90天内病死率;评价两组术后90天改良Rankin量表(mRS)评分,比较两组神经功能预后情况;评价比较术前、术后7天的美国国立卫生研究院卒中量表(NIHSS评分);分别在两组术前、术后7天取空腹静脉血,检测比较血清神经营养因子(NTF)、脑源性神经营养因子(BDNF)和血管内皮生长因子(VEGF)等神经损伤标志物水平;统计比较术后1个月内两组并发症发生率。结果:A组成功再通率、90天神经功能预后良好率、术后7天血清NTF、BDNF和VEGF水平均高于B组,而A组90天内血管再闭塞的发生率、90天内病变残余狭窄率及术后7天的NIHSS评分均低于B组(P<0.05)。与同组术前比较,两组术后7天血清NTF、BDNF和VEGF水平均升高而两组术后7天的NIHSS评分则均降低(P<0.05)。两组90天内病死率以及颅内出血、消化道出血、皮肤黏膜瘀斑等并发症发生率比较均无统计学差异(P>0.05)。结论:急性前后循环大动脉闭塞性脑梗死机械取栓术中动脉内注射替罗非班0.5 mg联合硝普钠0.2 mg有助于提高治疗效果和预防血管再闭塞,有助于术后神经功能损伤恢复,且安全可靠。Objective:To investigate the vascular reocclusion preventive effect of intraarterial administration of tirofiban combined with sodium nitroprusside in the treatment of acute anterior and posterior circulation aortic occlusive cerebral infarction.Methods:The clinical data of 80 patients with acute anterior and posterior circulation aortic occlusive cerebral infarction who underwent mechanical thrombectomy from August 2016 to July 2020 were retrospectively analyzed.All patients experienced a large amount of thrombus load during mechanical thrombectomy and needed to be performed intra-arterial drug injection therapy,and the patients were divided into group A(n=43)and group B(n=37)according to the situation of intra-arterial drug injection during mechanical thrombectomy.In group A,intra-arterial injection of tirofiban combined with sodium nitroprusside was performed,and in group B intra-arterial injection of tirofiban was performed.The successful recanalization rate,the vessel reocclusion rate within 90 days,the residual stenosis rate within 90 days,and the mortality rate within 90 days of the two groups were statistically compared.The modified Rankin Scale(mRS)scores of the two groups were evaluated 90 days after the operation.The prognosis of neurological function was compared between the two groups.National Institutes of Health Stroke Scale(NIHSS)scores before operation and 7 days after operation of the two groups were evaluated and compared.Fasting venous blood was taken before operation and 7 days after operation to detect and compare the levels of serum neurotrophic factor(NTF),brain-derived neurotrophic factor(BDNF),vascular endothelial growth factor(VEGF)and other markers of nerve damage in the two groups.The rate of complications in the two groups within 1 month after the operation was statistically compared.Results:The successful recanalization rate,90 d neurological function good prognosis rate,serum NTF,BDNF and VEGF levels 7 days after operation of group A were higher than those of group B,while the rate

关 键 词：急性脑梗死 大动脉闭塞 机械取栓 替罗非班 硝普钠 血管再闭塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R495.7[医药卫生—临床医学]