替罗非班在急性大血管闭塞性脑梗死机械取栓治疗中的应用效果分析  

Application effect analysis of tirofiban for mechanical thrombectomy in patients with acute large vessel occlusion cerebral infarction

作　　者：解鑫瑜 崔俊雷 杜大勇 李博[2] 张洪武[2] 张文龙[2] 侯延伟 张合亮[2] 郭再玉[2] Xie Xinyu;Cui Junlei;Du Dayong;Li Bo;Zhang Hongwu;Zhang Wenlong;Hou Yanwei;Zhang Heliang;Guo Zaiyu(Department of Neurology,Teda Hospital of Tianjin,Tianjin 300457,China;Department of Neurosurgery,Teda Hospital of Tianjin,Tianjin 300457,China)

机构地区：[1]天津市泰达医院神经内科,天津300457 [2]天津市泰达医院神经外科,天津300457

出　　处：《中华神经外科杂志》2024年第12期1239-1245,共7页Chinese Journal of Neurosurgery

基　　金：天津市滨海新区卫生和计划生育委员会重点支持课题(2017BWKZ003)。

摘　　要：目的探讨替罗非班在急性大血管闭塞性脑梗死患者机械取栓中的疗效及安全性。方法前瞻性纳入2018年10月至2022年12月天津市泰达医院神经内科和神经外科行机械取栓治疗急性大血管闭塞性脑梗死的218例患者的临床资料,根据围手术期是否应用替罗非班治疗分为研究组(109例)和对照组(109例)。取栓治疗48 h复查血小板计数,评估抗血小板药物治疗的差异;行头颅MRI检查观察梗死部位及有无颅内出血情况。治疗后48 h和10 d对患者进行美国国立卫生研究院卒中量表(NIHSS)评分,分别计算与治疗前NIHSS评分的差值,评估两组患者神经功能改善情况;采用改良脑梗死溶栓分级(mTICI)评估两组患者血管再通情况。治疗后3个月通过门诊、电话或视频随访等方式进行改良Rankin量表评分(mRS)评估两组患者的预后差异(mRS≤2分为预后良好,>2分为预后不良)。根据脑梗死部位的不同,研究组和对照组分别分为前循环亚组(分别为68、62例)、后循环亚组(分别为41、47例),分析亚组中研究组与对照组患者的基线资料、机械取栓后血管再通情况的差异。结果研究组与对照组患者的性别、年龄、合并非责任大动脉重度狭窄或闭塞等基线资料的差异均无统计学意义(均P>0.05)。研究组患者治疗后48 h和10 d的NIHSS评分[48 h:(9.34±3.90)分对比(10.74±4.39)分;10 d:(8.22±4.25)分对比(9.84±4.82)分]、48 h血管再闭塞率[5.50%(6/109)对比14.68%(16/109)]均较对照组低,治疗前后NIHSS评分差值[M(Q 1,Q 3),48 h与治疗前:6.00(4.00,8.00)分对比4.00(0,7.00)分;10 d与治疗前:7.00(4.00,10.00)分对比6.00(0.50,9.00)分]、血管再通率[88.07%(96/109)对比71.56%(78/109)]、≤3次取栓成功率[77.06%(84/109)对比60.55%(66/109)]、有效再通率[72.48%(79/109)对比55.05%(60/109)]、预后良好率[71.56%(78/109)对比56.88%(62/109)]均较对照组高,差异均有统计学意义(均P<0.05)。研究组与对照组患者在�ObjectiveTo explore the efficacy and safety of tirofiban for mechanical thrombectomy in patients with acute large vessel occlusion cerebral infarction.MethodsThe clinical data of 218 patients with acute large vascular occlusive cerebral infarction treated by mechanical thrombectomy in the Department of Neurosurgery and Department of Neurology of Tianjin Teda Hospital from October 2018 to December 2022 were prospectively included.The patients were divided into study group(109 cases)and control group(109 cases)according to whether tirofiban therapy during perioperative period was applied or not.Platelet count was rechecked 48 h after thrombectomy to evaluate the difference due to antiplatelet drug treatment.Cranial MRI was performed to observe the infarction site and the presence of intracranial hemorrhage.The National Institutes of Health Stroke Scale(NIHSS)was scored 48 h and 10 d after treatment,and the difference in the NIHSS between pretreatment and posttreatment periods was calculated to evaluate the improvement of neurological function in the two groups.The modified thrombolysis in cerebral infarction classification(mTICI)was used to evaluate the vascular recanalization in the two groups.The modified Rankin scale(mRS)was used to evaluate the outcome difference between the two groups through outpatient,telephone or video follow-up 3 months after treatment(mRS≤2 points for good outcome,>2 points for poor outcome).According to the different sites of cerebral infarction,the study group and the control group were divided into anterior circulation subgroup(68 and 62 cases,respectively)and posterior circulation subgroup(41 and 47 cases,respectively).The differences in baseline data and vascular recanalization after mechanical thrombectomy between the two groups were analyzed in the subgroups.ResultsThere were no significant differences in the baseline data such as gender,age,and combined severe stenosis or occlusion of non-responsible major arteries between the study group and control group(all P>0.05).The NIHSS

关 键 词：脑梗死 治疗结果 替罗非班 急性大血管闭塞 机械取栓 

分 类 号：R743.33[医药卫生—神经病学与精神病学]