动静脉序贯应用替罗非班治疗急性脑梗死的有效性与安全性  

Efficacy and safety of arteriovenous sequential tirofiban in the treatment of acute cerebral infarction

作　　者：余巧燕 魏孟丽 刘俊中 王妮妮 祝晓川 YU Qiaoyan;WEI Mengli;LIU Junzhong;WANG Ninia;ZHU Xiaochuan(Department of Neurology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,Henan,China;Department of Intervention,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州大学附属郑州中心医院神经内科,河南郑州450000 [2]郑州大学附属郑州中心医院介入科,河南郑州450000

出　　处：《右江医学》2024年第5期435-439,共5页Chinese Youjiang Medical Journal

摘　　要：目的探讨动静脉序贯应用替罗非班治疗急性脑梗死的有效性及安全性。方法回顾性分析2018年6月至2022年2月郑州大学附属郑州中心医院收治的134例超溶栓时间窗应用替罗非班治疗的非大动脉闭塞急性脑梗死患者的临床资料,选择美国国立卫生研究院卒中量表(NIHSS)评分5~16分的患者共80例,分为观察组(经动脉导管超选择性灌注替罗非班后序贯静脉泵入替罗非班,即动静脉序贯应用替罗非班)44例和对照组(直接静脉泵入替罗非班)36例。评估两组患者治疗后7 d、14 d时的NIHSS评分、有效率、出血率及病死率,并分析90 d良好预后的相关影响因素。结果治疗后7 d、14 d时观察组和对照组NIHSS评分差异无统计学意义(P>0.05)。观察组的有效率明显高于对照组(84.1%vs 63.9%),两组比较差异有统计学意义(χ^(2)=4.310,P=0.038)。两组患者均无明显出血、死亡事件发生,无药物不良反应,观察组无手术相关并发症。90 d预后的二分类logistic回归分析表明良好预后与动静脉序贯应用替罗非班[比值比(OR)=3.082,95%置信区间(CI)为(1.025,9.263),χ^(2)=4.017,P=0.045]、基线NIHSS评分[OR=1.230,95%CI(1.027,1.475),χ^(2)=5.036,P=0.025]相关。结论在超溶栓时间窗的非大动脉闭塞急性脑梗死且基线NIHSS评分5~16分患者,动静脉序贯应用替罗非班可以改善患者远期预后,具有临床应用价值。Objective To investigate the efficacy and safety of arteriovenous sequential tirofiban in the treatment of acute cerebral infarction.Methods The clinical data of 134 acute cerebral infarction patients without major arterial occlusion treated with tirofiban during the time window of thrombolysis in Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2018 to February 2022 were retrospectively analyzed.80 patients with National Institutes of Health Stroke Scale(NIHSS)scores ranging from 5 to 16 were selected and divided into observation group(superselective tirofiban perfusion via arterial catheterization with sequential intravenous pumping of tirofiban,i.e.arteriovenous and sequential application of tirofiban,44 cases)and control group(direct intravenous pumping of tirofiban,36 cases).The NIHSS score,effective rate,bleeding rate,and mortality rate of two groups of patients at 7 days and 14 days after treatment were evaluated,and relevant factors for a good prognosis at 90 days were analyzed.Results There was no statistically significant difference in NIHSS scores between the observation group and the control group on 7 days and 14 days after treatment(P>0.05).The effective rate of the observation group was significantly higher than that of the control group(84.1%vs 63.9%),and difference between the two groups was statistically significant(χ^(2)=4.310,P=0.038).No obvious bleeding,death events and adverse drug reactions occurred in the two groups,and no surgical related complications occurred in the observation group.A binary logistic regression analysis with a 90-day prognosis showed that a good prognosis was associated with sequential use of tirofiban in the arteries and veins(odds ratio[OR]=3.082,95%confidence interval[CI]was[1.025,9.263],χ^(2)=4.017,P=0.045)and baseline NIHSS score(OR=1.230,95%CI[1.027,1.475],χ^(2)=5.036,P=0.025).Conclusion For acute cerebral infarction patients without major arterial occlusion at the hyperthrombolysis time window and a baseline NIHSS score of 5 to 16,arter

关 键 词：急性脑梗死 替罗非班 动脉灌注 序贯治疗 

分 类 号：R743.33[医药卫生—神经病学与精神病学]