替罗非班在后循环大动脉闭塞性脑梗死机械取栓术中的应用  

The application of tirofiban in mechanical thrombectomy for cerebral infarction mth posterior circulatory artery occlusion

作　　者：卜香叶 夏文卿 蒋琳[1] 黄焕 汪荣 殷聪国[1] 牛国忠[1] Bu Xiangye

机构地区：[1]浙江大学医学院附属杭州市第一人民医院,310006

出　　处：《浙江临床医学》2022年第2期176-178,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY849);浙江省中医药科技计划项目(2021ZQ074);杭州市医药卫生科技计划项目(20200175);杭州市农业与社会发展科研一般项目(20181228Y01、20191203B93、20201203B185)。

摘　　要：目的探讨替罗非班在后循环大动脉闭塞性脑梗死机械取栓术中应用的有效性及安全性。方法回顾性分析56例接受机械取栓的后循环大动脉闭塞性脑梗死患者,根据术中是否使用替罗非班分为替罗非班组(35例)和非替罗非班组(21例)。使用χ^(2)检验和Mann-Whitney检验比较两组患者的颅内出血(ICH)、症状性颅内出血(sICH)、有效再灌注率、患者死亡率和90天良好预后率。结果替罗非班组的sICH(5.7%)和ICH(17.1%)发生率均明显高于非替罗非班组,但是两组之间的差异无统计学意义(P>0.05)。54例(96.4%)患者获得有效再灌注,替罗非班组的再灌注率为94.3%(33/35),非替罗非班组的再灌注率为100%,两组之间的差异无统计学意义(P>0.05)90天随访,共33例患者(58.9%)获得良好预后,替罗非班组21例(60%),非替罗非班组12例(57.1%),组间差异无统计学意义(P>0.05)。两组患者的30天死亡率(17.1%VS.14.3%)及90天死亡率(20.0%VS.14.3%)比较,差异均无统计学意义(P>0.05)。结论替罗非班联合机械取栓治疗后循环大动脉闭塞性脑梗死可改善患者的功能性预后,但可能增加术后ICH和sICH的风险。Objective To investigate the efficacy and safety of tirofiban in mechanical thrombectomy for cerebral infarction with posterior circulatory artery occlusion.Methods A retrospective analysis was performed on 56 patients with posterior circulation arterial occlusion cerebral infarction who received mechanical thrombectomy and were divided into tirofiban group(35 cases)and no-tirofiban group(21 cases)according to whether tirofiban was used during operation.Intracranial hemorrhage(ICH),symptomatic intracranial hemorrhage(sICH),effective reperfusion rate,patient mortality,and 90-day good outcome rate were compared between the two groups using the chi-square-test and the Mann-Whitney test.Results The incidence of sICH(5.7%)and ICH(17.1%)in tirofiban group was significantly higher than that in no-tirofiban group,but there was no statistical significance between the two groups(P>0.05).Effective reperfusion was achieved in 54 patients(96.4%),and the reperfusion rate was 94.3%(33/35)in the tirofiban group and 100% in the no-tirofiban group,the difference between the two groups was not statistically significant(P>0.05).At the 90-day follow-up,33 patients(58.9%)had a good prognosis,including 21 patients(60%)in the tirofiban group and 12 patients(57.1%)in the no-tirofiban group,with no significant difference between the groups(P>0.05).There was no significant difference in 30-day mortality(17.1%VS.14.3%)and 90-day mortality(20.0%VS.14.3%)between tvvo groups(P>0.05).Conclusion Tirofiban combined with mechanical thrombectomy in patients with posterior circulatory arterial occlusion cerebral infarction improves funcrional outcome,but may increase the risk of postoperative ICH and sICH.

关 键 词：脑梗死 替罗非班 机械取栓 脑出血 

分 类 号：R74[医药卫生—神经病学与精神病学]