替罗非班联合急性支架植入在后循环缺血性卒中机械取栓患者中的应用研究  

Application of tirofiban combined with emergency stenting in the endovascularthrombectomy of patients with PCIS

作　　者：赵宜坤 孙勇[1] ZHAO Yikun;SUN Yong(Department of Neurosurgery,Lianyungang Clinical College of Nanjing Medical University/the First People’s Hospital of Lianyungang,Lianyungang,Jiangsu 222000,China)

机构地区：[1]南京医科大学连云港临床医学院,江苏连云港222000

出　　处：《重庆医学》2023年第S01期35-38,共4页Chongqing medicine

摘　　要：目的探讨替罗非班联合支架植入补救性治疗后循环缺血性卒中(PCIS)机械取栓术后残余血管狭窄或闭塞的疗效及安全性。方法回顾性分析2019年1月至2022年5月因急性基底动脉闭塞于连云港市第一人民医院行机械血栓去除术的66例患者资料,根据术中是否行替罗非班联合支架植入分为支架植入组(n=25)和单纯取栓组(n=41)。研究的主要临床结局为90 d良好预后率(定义为mRS评分0~2分),主要安全性结局为症状性颅内出血(sICH)发生率,其他次要安全性结局包括取栓术后出血转化发生率及90 d全因死亡率。结果支架植入组32.0%和单纯取栓组22.0%的患者术前接受了静脉溶栓治疗。与单纯取栓组比较,支架植入组年龄更高,手术时间更长,差异有统计学意义(P<0.05)。两组90 d良好预后率、sICH发生率、术后出血转化率和90 d全因死亡率比较,差异无统计学意义(P>0.05)。年龄、入院NIHSS评分与预后相关,年龄越高(OR=1.062,95%CI:1.004~1.124,P=0.036)、入院NIHSS评分越高,预后越差(OR=1.170,95%CI:1.050~1.304,P=0.005)。结论替罗非班联合急性椎-基底动脉支架植入作为PCIS机械取栓的补救性治疗安全有效。Objective To investigate the efficacy and safety of tirofiban combined with emergency stenting in the endovascular thrombectomy of PCIS.Methods The data of PCIS patients who underwent endovascular thrombectomy in First People’s Hospital of Lianyungang from January 2020 to May 2022 were retrospectively analyzed,and were divided into the emergency stenting group(n=25)and the thrombectomy group(n=41)according to whether stent was implanted or not.The primary outcome was 90-day mRS Score 0-2,the primary safety outcome was the occurrence of sICH.Secondary safety outcomes included the conversion of hemorrhage after thrombectomy and 90-day all-cause mortality.Results 32.0%of patients in the stent implantation group and 22.0%in the thrombectomy group received intravenous thrombolysis before surgery.Compared with the thrombectomy group,the stent implantation group was older and the operation time was longer,and the difference was statistically significant(P<0.05).There were no significant differences in the 90-day good prognosis rate,sICH incidence,postoperative bleeding conversion rate and 90-day all-cause mortality between the two groups(P>0.05).Age and admission NIHSS score were correlated with prognosis.The higher the age(OR=1.062,95%CI:1.004-1.124,P=0.036)and admission NIHSS score,the worse the prognosis(OR=1.170,95%CI:1.050-1.304,P=0.005).Conclusion Tirofiban combined with emergency stenting is safe and effective as a remedial treatment for mechanical thrombectomy of PCIS.

关 键 词：替罗非班 紧急支架植入 后循环缺血性卒中 预后 机械取栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]