阿替普酶静脉溶栓治疗脑梗死患者的再闭塞影响因素及替罗非班治疗效果  

Influencing factors of re-occlusion after intravenous thrombolysis of alteplase in patients with cerebral infarction and therapeutic effect of tirofiban

作　　者：徐忠海[1] 代允义[1] 马瑜[1] 代全德[1] XU Zhonghai;DAI Yunyi;MA Yu;DAI Quande(Department of Neurology,the First People′s Hospital of Shangqiu in Henan Province,Shangqiu,Henan,476100)

机构地区：[1]河南省商丘市第一人民医院神经内科,河南商丘476100

出　　处：《实用临床医药杂志》2024年第2期28-31,37,共5页Journal of Clinical Medicine in Practice

基　　金：河南省医学科技攻关计划项目(LHGJ20191487)。

摘　　要：目的探讨脑梗死患者阿替普酶静脉溶栓后再闭塞的影响因素及替罗非班的治疗效果。方法选取100例脑梗死患者作为研究对象,根据阿替普酶静脉溶栓后是否再闭塞分为闭塞组(n=42)和非闭塞组(n=58)。闭塞组给予替罗非班治疗。比较2组一般资料。采用Logistic回归模型分析脑梗死患者阿替普酶静脉溶栓后再闭塞的影响因素。观察闭塞组治疗总有效率、重组人组织型纤溶酶原激酶衍生物(rPA)、纤溶酶原激活物抑制剂1(PAI-1)水平以及美国国立卫生研究院卒中量表(NIHSS)、简易精神状态量表(MMSE)评分。结果2组在2型糖尿病、血糖、收缩压、NIHSS评分、起病-溶栓时间方面比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,2型糖尿病、血糖、收缩压、NIHSS评分、起病-溶栓时间是脑梗死患者阿替普酶静脉溶栓后再闭塞的影响因素(P<0.05)。42例溶栓后再闭塞患者经替罗非班治疗后总有效率为88.10%(37/42)。治疗3、7 d,rPA高于治疗前,PAI-1低于治疗前,差异有统计学意义(P<0.05);治疗1、2、4周,MMSE评分高于治疗前,NIHSS评分低于治疗前,差异有统计学意义(P<0.05)。结论2型糖尿病、血糖、收缩压、NIHSS评分、起病-溶栓时间可对脑梗死患者阿替普酶静脉溶栓后再闭塞产生影响。再闭塞后予以替罗非班治疗的效果较为理想,有利于改善患者神经功能与rPA、PAI-1水平。Objective To investigate the influence factors of re-occlusion after intravenous thrombolysis of alteplase in patients with cerebral infarction and the therapeutic effect of tirofiban.Methods A total of 100 patients with cerebral infarction were selected as the study objects.The patients were divided into occlusion group(n=42)and non-occlusion group(n=58)according to whether re-occlusion after intravenous thrombolysis with alteplase.The occlusion group was given tirofiban treatment.General data were compared between two groups.Logistic regression model was used to analyze the influencing factors of re-occlusion after alteplase intravenous thrombolysis in patients with cerebral infarction.The total effective rate,recombinant human tissue plasminogen activator(rPA),plasminogen activator inhibitor-1(PAI-1)levels and the score of National Institutes of Health Stroke Scale(NIHSS)and Simple Mental State Scale(MMSE)in the occlusion group were observed.Results There were statistically significant differences in type 2 diabetes mellitus,blood glucose,systolic blood pressure,NIHSS score and onset-thrombolysis time between the two groups(P<0.05).Logistic regression analysis showed that type 2 diabetes mellitus,blood glucose,systolic blood pressure,NIHSS score,and onset-thrombolytic time were the influential factors of re-occlusion after intravenous thrombolytic alteplase in cerebral infarction patients(P<0.05).The total effective rate was 88.10%(37/42)in 42 patients with re-occlusion after thrombolytic therapy.After 3 and 7 days of treatment,rPA was significantly higher than before treatment,PAI-1 was significantly lower than before treatment(P<0.05);after 1 week,2 and 4 weeks of treatment,MMSE score was significantly higher than before treatment,NIHSS score was significantly lower than before treatment(P<0.05).Conclusion Type 2 diabetes mellitus,blood glucose,systolic blood pressure,NIHSS score,and time of onset and thrombolytic therapy may affect the re-occlusion of patients with cerebral infarction after alteplase intrav

关 键 词：脑梗死 阿替普酶 静脉溶栓 再闭塞 替罗非班 治疗效果 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R446[医药卫生—临床医学] R322.81