急性缺血性脑卒中取栓治疗后联用替罗非班静脉维持的临床研究  

Clinical study on intravenous maintenance of tirofiban after thrombectomy in patients with acute ischaemic stroke

作　　者：呙登俊[1] 潘勇 余自强 张震中[1] Guo Dengjun;Pan Yong;Yu Ziqiang;Zhang Zhenzhong(Department of Neurology,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)

机构地区：[1]浙江省立同德医院神经内科,杭州310012

出　　处：《中华危重症医学杂志（电子版）》2022年第3期205-209,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省科技厅公益技术应用研究项目(2017C33114)。

摘　　要：目的探讨替罗非班治疗作为补充手段用于未接受静脉溶栓的急性缺血性脑卒中(AIS)患者机械取栓(MT)后静脉维持治疗的可行性与安全性。方法入选不符合静脉溶栓条件且CT血管成像证实为大动脉闭塞的87例AIS患者,其中MT+替罗非班维持(MT+T)组44例,MT组43例。MT+T组患者采用支架取栓并在术后立即静脉泵入0.1μg·kg-1·min-1替罗非班维持24 h,之后口服抗血小板聚集药物;MT组患者采用支架取栓治疗,术后口服抗血小板聚集药物。比较两组患者术前基线资料、血管再通情况、神经功能恢复情况、术后并发症及死亡情况。结果MT+T组与MT组患者术后14 d美国国立卫生研究院卒中量表(NIHSS)评分[(7.7±2.2)分vs.(8.8±3.3)分]、术后并发症[4.55%(2/44)vs.6.98%(3/43)]及病死率[2.27%(1/44)vs.2.33%(1/43)]比较,差异均无统计学意义(P均>0.05);而MT+T组患者术后90 d改良Rankin量表(mRS)评分低于MT组[(1.7±1.0)分vs.(2.2±1.1)分,t=2.479,P=0.015]。亚组分析显示,MT+T组取栓次数>3次的患者术后14 d NIHSS评分[(8.6±3.1)分vs.(12.5±3.5)分]及术后90 d mRS评分[(1.7±1.5)分vs.(2.8±1.0)分]均低于MT组(t=2.996、2.172,P=0.006、0.040);MT+T组及MT组取栓次数≤3次的患者术后14 d NIHSS评分[(7.4±1.6)分vs.(7.2±1.5)分]及术后90 d mRS评分[(1.7±0.7)分vs.(2.0±1.1)分]比较差异均无统计学意义(t=0.441、1.362,P=0.661、0.178)。结论替罗非班可作为未接受静脉溶栓的AIS患者行3次以上支架取栓治疗后的补充手段,可有效改善患者的神经功能及预后,且不增加脑出血转化风险。Objective To explore the feasibility and safety of tirofiban as a supplement for intravenous maintenance therapy after mechanical thrombectomy(MT)in patients with acute ischaemic stroke(AIS)who were ineligible for intravenous thrombolysis with recombinant tissue plasminogen activator(rtPA).Methods A total of 87 AIS patients who were ineligible for rtPA intravenous thrombolysis and diagnosed with large vessel occlusions by computed tomography angiography were enrolled in this study and divided into a MT+tirofiban(T)group(n=44)and a MT group(n=43).After the occluded vessels were recanalized,patients in the MT+T group were maintained with intravenous infusion of 0.1μg·kg-1·min-1 tirofiban for continuous 24 h and then followed by oral antiplatelet agents while patients in the MT group were followed by oral antiplatelet agents directly.Preoperative baseline data,vascular recanalization,neurological recovery,postoperative complications,and mortality were compared between the two groups.Results There was no significant difference in the National Institutes of Health stroke scale(NIHSS)scores at 14 d after surgery[(7.7±2.2)vs.(8.8±3.3)],postoperative complications[4.55%(2/44)vs.6.98%(3/43)]and mortality[2.27%(1/44)vs.2.33%(1/43)]between the two groups of patients(all P>0.05),while the modified Rankin scale(mRS)scores at 90 d after surgery in the MT+T group were lower than those in the MT group[(1.7±1.0)vs.(2.2±1.1),t=2.479,P=0.015].Further sub-group analysis was conducted.Compared with those underwent thrombectomy for more than 3 times in the MT group,NIHSS scores at 14 d[(12.5±3.5)vs.(8.6±3.1)]and mRS scores at 90 d[(2.8±1.0)vs.(1.7±1.5)]after surgery were both lower in the MT+T group(t=2.996,2.172;P=0.006,0.040).There were no significant difference in NIHSS scores at 14 d[(7.4±1.6)vs.(7.2±1.5)]and mRS scores at 90 d[(1.7±0.7)vs.(2.0±1.1)]after surgery between the two sub-groups with the number of thrombectomy≤3 times(t=0.441,1.362;P=0.661,0.178).Conclusion Tirofiban can effectively improve functional r

关 键 词：急性缺血性脑卒中 支架 机械取栓 替罗非班 症状性出血转化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]