替罗非班联合Solumbra取栓对急性颅内外大动脉闭塞脑梗死血管再通率及预后的影响  

Effect of tirofiban combined with Solumbra embolization on the vascular recanalization rate and prognosis of acute cerebral infarction caused by intracranial and extracranial large artery occlusion

作　　者：王荣辉 王小卫 张博刚 WANG Rong-hui;WANG Xiao-wei;ZHANG Bo-gang(Department of Neurology,the Third Hospital of Xingtai City,Hebei Province,Xingtai 054000,China)

机构地区：[1]河北省邢台市第三医院神经内科,河北邢台054000

出　　处：《河北医科大学学报》2023年第7期792-797,共6页Journal of Hebei Medical University

基　　金：邢台市科技局重点研发计划项目(2020ZC331)。

摘　　要：目的 探讨替罗非班联合Solumbra技术机械取栓在急性颅内外大动脉闭塞脑梗死中的应用,并分析其对血管再通率、血小板功能及预后的影响。方法 选取急性颅内外大动脉闭塞脑梗死患者120例,按照介入治疗后用药不同分组,各60例。2组均行Solumbra技术机械取栓,对照组于取栓后给予阿司匹林联合氯吡格雷,观察组于取栓后给予替罗非班。比较2组临床疗效、血管再通率、治疗前后脑血流情况[大脑中动脉平均血流速度(mean blood flow velocity,Vm)、收缩期峰值血流速度(peak systolic flow velocity,Vs)、舒张末期血流速度(end-diastolic blood velocity,Vd)]、血小板功能指标[平均血小板体积(mean platelet volume,MPV)、血小板聚集率(platelet aggregation rate,PAgT)、血小板黏附率(platelet adhesion rate,PAdT)、血小板P-选择素(P-selectin)]、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、日常生活活动能力(Barthel指数测评)、预后情况[改良Rankin量表(modified Rankin Scale,mRS)评分]及出血并发症发生率、病死率。结果 观察组总有效率、血管再通率高于对照组(P<0.05)。2组大脑中动脉Vm、Vs、Vd均随着治疗的时长而增高,观察组增高地更明显,组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05)。2组MPV、PAgT、PAdT、P-selectin水平随治疗时长的延长而降低,且观察组降低地更明显,组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05)。2组NIHSS评分、mRS评分随治疗时长的延长而降低,且观察组降低地更明显,Barthel指数随着治疗的时长而增高,观察组增高地更明显,组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05)。治疗后90 d 2组出血并发症发生率、病死率差异无统计学意义(P>0.05)。结论 替罗非班联合Solumbra技术机械取栓应用于急性颅内外大动脉闭塞脑梗Objective To investigate the application of tirofiban combined with Solumbra technique for mechanical embolization in acute cerebral infarction caused by intracranial and extracranial large artery occlusion,and to analyze its effects on vascular recanalization rate,platelet function and prognosis.Methods A total of 120 patients with acute cerebral infarction caused by intracranial and extracranial large artery occlusion were selected,and they were grouped according to different medications used after intervention,with 60 patients in each group.Both groups underwent mechanical embolization by Solumbra technique,the control group was given aspirin combined with clopidogrel after embolization,and the observation group was given tirofiban after embolization.The clinical efficacy,vascular recanalization rate,cerebral blood flow[meanblood flow velocity(Vm)of middle cerebral artery,peak systolic flow velocity(Vs),end-diastolic flow velocity(Vd)],platelet function indexes[mean platelet volume(MPV),platelet aggregation rate(PAgT),platelet adhesion rate(PAdT),platelet P-selectin],neurological function[National Institute of Health Stroke Scale(NIHSS)]score,activities of daily living[Barthel index(BI)score],prognosis[modified rankin scale(mRs)score]and incidence of bleeding complications,and mortality were compared between two groups.Results The total effective rate and vascular recanalization rate of the observation group were higher than those of the control group(P<0.05).The Vm,Vs,and Vd of the middle cerebral arteries in both groups increased with the duration of treatment,and the observation group showed a more significant increase;The difference between groups,time points,and time points between groups was statistically significant(P<0.05).The levels of MPV,PAgT,PAdT,and P-selectin in the two groups decreased with the prolongation of treatment,and the observation group showed a more significant decrease.The difference between groups,time points,and time points between groups was statistically significant(P<0.05).The NI

关 键 词：大脑梗死 Solumbra技术 替罗非班 

分 类 号：R743.33[医药卫生—神经病学与精神病学]