替罗非班与阿加曲班治疗急性脑梗死静脉溶栓后早期神经功能恶化患者的疗效比较  

Comparison of the curative effect of tirofiban and argatroban in the treatment of early neurological deterioration patients after intravenous thrombolysis in acute cerebral infarction

作　　者：孙冉冉 刘卫东[2] SUN Ranran;LIU Weidong(Department of Neurology,Liaocheng Brain Hospital,Shandong Province,Liaocheng 252000,China;不详)

机构地区：[1]山东省聊城市人民医院脑科医院神经内科,252000 [2]山东省聊城市人民医院脑科医院神经外科,252000

出　　处：《临床合理用药杂志》2024年第21期16-20,共5页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的 比较替罗非班与阿加曲班治疗急性脑梗死静脉溶栓后早期神经功能恶化(END)的疗效。方法 回顾性选取2020年6月—2021年6月聊城市人民医院脑科医院收治的急性脑梗死静脉溶栓后END患者140例,按照不同用药分为替罗非班组和阿加曲班组,各70例。比较2组有效率、预后良好率、不良事件发生率,并比较2组不同梗死部位、TOAST分型患者的有效率及治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、血浆纤维蛋白原(Fib)]。结果 2组患者有效率、预后良好率及不良事件发生率比较,差异均无统计学意义(P>0.05)。按梗死部位,2组前、后循环梗死患者有效率比较,差异均无统计学意义(P>0.05)。替罗非班组小动脉闭塞型患者有效率高于阿加曲班组,心源性栓塞型患者有效率低于阿加曲班组(P<0.05);2组大动脉粥样硬化型患者有效率比较,差异无统计学意义(P>0.05)。治疗后,2组患者NIHSS评分、血浆Fib水平低于治疗前,APTT、PT、TT长于治疗前,替罗非班组患者APTT、PT、TT短于阿加曲班组(P<0.05或P<0.01)。结论 替罗非班与阿加曲班治疗急性脑梗死静脉溶栓后END患者的有效率均较高,均可改善患者预后,但对于小动脉闭塞型患者应用替罗非班治疗效果更佳,心源性栓塞型患者应用阿加曲班治疗效果更佳。Objective To compare the curative effect of tirofiban and argatroban in the treatment of END patients after intravenous thrombolysis in acute cerebral infarction.Methods Data of 140 cases of END patients after intravenous thrombolysis in acute cerebral infarction who were hospitalized in Liaocheng Brain Hospital from June 2020 to June 2021 were retrospectively collected,and they were divided into the tirofiban group and the argatroban group according to different drugs,70 cases in each group.Effective rate,good prognosis rate,adverse events rate,and effective rate of patients with different infarction sites and TOAST classification types,NIHSS score,coagulation indexes(APTT,PT,TT,plasma Fib)before and after treatment were compared between the two groups.Results There was no significant difference of effective rate,good prognosis rate or incidence of adverse events between the two groups(P>0.05).According to the infarction site,the efficacy rate of patients with anterior and posterior circulation was no statistical difference(P>0.05).The efficacy rate of patients with arteriole occlusion in the tirofiban group was higher than that of the agatroban group,efficacy rate of patients with cardiogenic embolism in the tirofiban group was lower than that of the agatroban group(P<0.05).There was no significant difference of efficacy rate in patients with atherosclerosis of aorta between the two groups(P>0.05).After treatment,both groups showed significant decrease in NIHSS score and plasma Fib level,prolonged APTT,PT,TT,and APTT,PT,TT in the tirofiban group were shorter than those of the agatroban group(P<0.05 or P<0.01).Conclusion Both tirofiban and argatroban are effective in the treatment of patients with END after intravenous thrombolysis in acute cerebral infarction,which can improve the prognosis of patients,however,tirofiban is better for patients with arteriole occlusion,and argatroban is better for patients with cardiogenic embolism.

关 键 词：早期神经功能恶化 急性脑梗死 静脉溶栓 替罗非班 阿加曲班 

分 类 号：R743.33[医药卫生—神经病学与精神病学]