动脉内注射替罗非班对急性前循环大血管闭塞再通术后神经功能预后的影响  

Effects of intra-arterial tirofiban injection on neurological functional prognosis after recanalization of acute anterior circulation large vessel occlusion

作　　者：陈科春 施惠敏 张雯君 曹丽丹 Chen Kechun;Shi Huimin;Zhang Wenjun;Cao Lidan(Department of Neurology,Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang 215600,China)

机构地区：[1]苏州大学附属张家港医院神经内科,215600

出　　处：《心脑血管病防治》2023年第9期35-38,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：苏州市科技发展计划项目(SKY2023019)。

摘　　要：目的评估动脉内注射替罗非班对急性前循环大血管闭塞性脑卒中患者机械取栓成功再通后神经功能预后的影响。方法回顾分析2018年2月至2022年4月在苏州大学附属张家港医院行机械取栓且成功再通的急性前循环大血管闭塞性脑卒中患者,根据术中动脉内注射替罗非班或生理盐水将其分为给药组62例和对照组80例,比较两组间术后血清神经元特异烯醇化酶和中枢神经特异性蛋白水平,评估术后24 h早期神经功能恶化及术后90 d神经功能预后情况,采用多因素Logistic回归分析早期神经功能恶化的影响因素。结果给药组患者血清神经元特异烯醇化酶和中枢神经特异性蛋白水平、早期神经功能恶化的比例显著低于对照组(χ^(2)/Z=5.645、3.015、10.782,P<0.01),两组间90 d良好预后比例和颅内出血转化无统计学差异(P>0.05),多因素Logistic回归分析显示较长的发病至穿刺时间和未动脉注射替罗非班[OR(95%CI)=1.021(1.005~1.042)、7.917(2.507~25.006),P<0.05]为早期神经功能恶化的危险因素。结论急性前循环大血管闭塞性脑卒中患者机械取栓成功再通的,动脉内注射替罗非班可降低血清中神经损伤标志物水平,降低早期神经功能恶化,但对患者术后90 d神经功能预后无显著影响。Objective To evaluate the impact of intra-arterial tirofiban injection on neurological functional prognosis after successful recanalization by mechanical thrombectomy in patients with acute anterior circulation large vessel occlusion.Methods A retrospective analysis was conducted on patients with acute anterior circulation large vessel occlusion who underwent successful recanalization by mechanical thrombectomy in Zhangjiagang Hospital Affiliated to Soochow University from February 2018 to April 2022.Patients were divided into the medication group(62 cases)and the control group(80 cases)based on intra-arterial injection of tirofiban or saline during the procedure.Changes in serum neuronspecific enolase(NSE)and central nerve-specific protein levels were compared between the two groups.Early neurological functional deterioration within 24 hours after the procedure and neurological functional prognosis at 90 days after the procedure were evaluated.Factors affecting early neurological functional deterioration were analyzed using multivariate logistic regression.Results Patients in the medication group showed significantly lower levels of serum NSE and central nerve-specific protein,as well as a lower proportion of early neurological functional deterioration compared to the control group(χ^(2)/Z=5.645,3.015,10.782;P<0.01).There were no significant differences between the two groups in terms of the proportion of good prognosis at 90 days and the conversion of intracranial hemorrhage(P>0.05).Multivariate logistic regression analysis indicated that long time from onset to puncture and absence of intra-arterial tirofiban injection[OR(95%CI)=1.021(1.005-1.042),7.917(2.507-25.006);P<0.05]were independent risk factors for early neurological functional deterioration.Conclusion In patients with acute anterior circulation large vessel occlusion who underwent successful mechanical thrombectomy,intra-arterial tirofiban injection can reduce the level of serum nerve injury biomarker,decrease the rate of early neurological function

关 键 词：机械取栓 动脉内注射替罗非班 神经损伤标志物 神经功能 

分 类 号：R969[医药卫生—药理学]