替罗非班对老年急性前循环颅内动脉粥样硬化性脑卒中机械取栓患者的疗效和安全性  

Efficacy and safety of tirofiban in elderly patients with acute anterior circulation ICAS-LVO undergoing mechanical thrombectomy

作　　者：徐松 郭永涛 李明超[1] Xu Song;Guo Yongtao;Li Mingchao(Department of Neurology,Huai'an First Hospital Affiliated to Nanjing Medical University,Huai'an 223300,Jiangsu Province,China)

机构地区：[1]南京医科大学附属淮安第一医院神经内科,223300

出　　处：《中华老年心脑血管病杂志》2024年第10期1182-1186,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨老年急性前循环颅内动脉粥样硬化性狭窄相关大血管闭塞(intracranial atherosclerotic stenosis-related large vessel occlusion,ICAS-LVO)机械取栓患者术后替罗非班静脉滴注的疗效和安全性。方法回顾性分析2021年6月至2023年8月南京医科大学附属淮安第一医院老年急性前循环ICAS-LVO机械取栓患者106例,术后替罗非班静脉滴注48 h作为试验组38例,替罗非班静脉滴注24 h作为对照组68例。替罗非班静脉滴注速率为0.1μg/(kg·min)。比较2组疗效指标和安全性指标。疗效指标为90 d良好预后率;安全性指标包括颅内出血(intracranial hemorrhage,ICH)、症状性颅内出血(symptomatic intracranial hemorrhage,sICH)及90 d病死率。采用多因素logistic回归分析90 d良好预后的影响因素。结果试验组术后90 d良好预后率明显高于对照组(52.6%vs 29.4%,P=0.018)。2组ICH、sICH、90 d死亡比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示,替罗非班静脉滴注48 h(OR=2.554,95%CI:1.067~6.116,P=0.034)及入院时美国国立卫生研究院卒中量表评分(OR=0.887,95%CI:0.822~0.957,P=0.001)是老年急性前循环ICAS-LVO机械取栓患者90 d预后的独立影响因素。结论老年急性前循环ICAS-LVO机械取栓患者术后替罗非班静脉滴注48 h较24 h可以改善90 d预后,不增加sICH风险。Objective To explore the efficacy and safety of intravenous infusion of tirofiban after mechanical thrombectomy in elderly patients with acute anterior circulation intracranial atherosclerotic stenosis-related large vessel occlusion(ICAS-LVO).Methods A retrospective analysis was conducted on 106 elderly patients with acute anterior circulation ICAS-LVO undergoing mechanical thrombectomy in our hospital from June 2021 to August 2023.After operation,38 patients receiving 48-hour intravenous infusion of tirofiban at a drip rate of 0.1 μg/(kg·min) were assigned into experimental group,while the other 68 patients undergoing the infusion for only 24 h served as the control group.The indicators related to efficacy(90-day good prognosis rate) and to safety [intracerebral hemorrhage(ICH),symptomatic intracerebral hemorrhage(sICH),and 90-day mortality rate] were compared between the 2 groups.Multivariate logistic regression model was employed to analyze the influencing factors for good prognosis.Results The experimental group exhibited a significantly higher rate of 90-day favorable prognosis than the control group(52.6% vs 29.4%,P=0.018),but no significant differences were observed in the rates of ICH,sICH,and 90-day mortality between the 2 groups(P>0.05).Multivariate logistic regression analysis indicated that intravenous tirofiban administration for 48 h(OR=2.554,95%CI:1.067-6.116,P=0.034) and NIHSS score at admission(OR=0.887,95%CI:0.822-0.957,P=0.001) were independent influencing factors for 90-day prognosis in elderly patients undergoing mechanical thrombectomy due to acute anterior circulation ICAS-LVO.Conclusion In elderly acute anterior circulation ICAS-LVO patients receiving mechanical thrombectomy,postoperative intravenous tirofiban infusion for 48 h shows better improvement for 90-day prognosis than for 24 h,and has no effect on increasing the risk of sICH.

关 键 词：前循环 动脉粥样硬化 支架取栓术 替罗非班 

分 类 号：R743.3[医药卫生—神经病学与精神病学]