动脉灌注替罗非班在急性心源性脑栓塞患者血管再通术中的疗效评估  

Safety and efficacy of intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism undergoing endovascular reperfusion therapy

作　　者：林甜 杜娟 刘丽 吴铮 孔祥锴 段文博 杜彬 于一娇 文婉玲 蔡艺灵 Lin Tian;Du Juan;Liu Li;Wu Zheng;Kong Xiangkai;Duan Wenbo;Du Bin;Yu Yijiao;Wen Wanling;Cai Yiling(Department of Neurology,Strategic Support Force Medical Center,Beijing 100101,China)

机构地区：[1]解放军战略支援部队特色医学中心神经内科,北京100101

出　　处：《中华内科杂志》2022年第4期397-402,共6页Chinese Journal of Internal Medicine

摘　　要：目的探讨动脉灌注替罗非班在急性心源性脑栓塞患者血管再通术中的疗效及安全性。方法回顾性分析2015年8月至2020年8月解放军战略支援部队特色医学中心收治的72例急性心源性脑栓塞患者的临床资料。所有患者均急诊行脑血管再通术,其中52例患者术中予以动脉灌注替罗非班治疗,20例患者未予以替罗非班治疗。通过对比两组患者的基线资料、术后责任血管改良脑梗死溶栓血流(mTICI)评分、术后90 d改良Rankin量表(mRS)评分、症状性颅内出血发生率及病死率,探讨动脉灌注替罗非班在急性心源性脑栓塞患者血管再通术中的疗效及安全性。结果术后替罗非班组患者责任血管获得有效再通(mTICI≥2b)的比例高于对照组(92.3%比75.0%),但差异无统计学意义(P=0.104)。术后90 d,替罗非班组患者(61.5%)获得良好预后的比例(mRS≤2分)高于对照组(35.0%)(P<0.05)。两组患者治疗后症状性颅内出血的发生率及病死率差异无统计学意义(P值均>0.05)。结论急性心源性脑栓塞患者血管再通术中动脉灌注替罗非班具有良好的效果及可行性,可改善患者预后,并不增加患者出血的概率。Objective To evaluate the safety and efficacy of intra-arterial tirofiban infusion during endovascular reperfusion therapy in patients with acute cardiogenic cerebral embolism.Methods Clinical data of 72 patients with acute cardiogenic cerebral embolism caused by large artery occlusion were retrospectively analyzed in Department of Neurology,Strategic Support Force Medical Center from August 2015 to August 2020.Among those,52 patients were treated with intra-arterial tirofiban,the other 20 patients were treated with control medication.The baseline characteristics,modified thrombolysis in cerebral infarction(mTICI)score of responsible vessels,modified Rankin scale(mRS)score 90 days after operation,incidence of symptomatic intracranial hemorrhage and mortality were evaluated and compared in two groups.Results The proportion of effective recanalization of the offending vessels(mTICI≥2b)in tirofiban group was higher than that in control group(92.3%vs.75.0%),but the difference was not statistically significant(P=0.104).At 90 days after operation,the rate of patients with good prognosis(mRS≤2)in tirofiban group(61.5%)was significantly higher than that in control group(35.0%)(P<0.05).The incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups(P>0.05).Conclusion Intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism is effective and feasible,which improves the prognosis without increasing the risk of intracranial bleeding complications.

关 键 词：替罗非班 心源性脑栓塞 血管再通术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]