替罗非班动静脉序贯治疗超溶栓时间窗急性缺血性脑卒中患者的临床疗效  

Clinical Efficacy of Sequential Arterial-Venous with Tirofiban for Patients with Acute Ischemic Stroke Beyond the Thrombolytic Time Window

作　　者：梁婷婷 孔令胜 常焕显 洪波 韩学聃 徐玲[1] 张晓 LIANG Tingting;KONG Lingsheng;CHANG Huanxian;HONG Bo;HAN Xuedan;XU Ling;ZHANG Xiao(Department of Neurology,Lianyungang Municipal Oriental Hospital Affiliated to Kangda College of Nanjing Medical University,Lianyungang 222042,China)

机构地区：[1]南京医科大学康达学院附属连云港市立东方医院神经内科,江苏省连云港市222042

出　　处：《实用心脑肺血管病杂志》2025年第3期111-115,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：南京医科大学康达学院科研发展基金课题计划项目(KD2022KYJJZD143)。

摘　　要：目的探讨替罗非班动静脉序贯治疗超溶栓时间窗急性缺血性脑卒中(AIS)患者的临床疗效。方法选取2022年7月—2024年3月南京医科大学康达学院附属连云港市立东方医院神经内科收治的超溶栓时间窗AIS患者120例作为研究对象,采用随机数字表法将患者分为静脉组与序贯组,各60例。静脉组患者采用替罗非班静脉治疗,序贯组患者采用替罗非班动静脉序贯治疗。比较两组治疗前、治疗48 h后血小板聚集抑制率、血小板活性及替罗非班总用量,治疗前、治疗14 d后炎症反应指标(血清IL-6、TNF-α水平)、美国国立卫生研究院卒中量表(NIHSS)评分,治疗前、治疗后3个月改良Barthel指数(mBI)、改良Rankin量表(mRS)评分,并观察两组不良事件发生情况。结果两组治疗前及治疗48 h后血小板聚集抑制率、血小板活性及替罗非班总用量比较,差异无统计学意义(P>0.05)。治疗14 d后,序贯组血清IL-6、TNF-α水平及NIHSS评分低于静脉组(P<0.05)。治疗后3个月,序贯组mBI高于静脉组,mRS评分低于静脉组(P<0.05)。两组症状性颅内出血转化、非症状性颅内出血转化、其他部位出血发生率比较,差异无统计学意义(P>0.05);序贯组血管再闭塞发生率低于静脉组(P<0.05)。结论替罗非班动静脉序贯治疗可有效减轻超溶栓时间窗AIS患者的炎症反应及神经功能缺损程度,提高日常生活活动能力,改善患者预后,降低血管再闭塞风险,且不会增加出血转化发生风险,安全性较高。Objective To discuss the clinical efficacy of sequential arterial-venous with tirofiban for patients with acute ischemic stroke(AIS)beyond the thrombolytic time window.Methods From July 2022 to March 2024,120 AIS patients beyond the thrombolytic time window from the Department of Neurology,Lianyungang Municipal Oriental Hospital Affiliated to Kangda College of Nanjing Medical University were selected as study objects.Patients were divided into the intravenous group and the sequential group by random number table method,with 60 cases in each group.Patients in the intravenous group were treated with tirofiban intravenously,and patients in the sequential group were treated sequential arterial-venous with tirofiban.The platelet aggregation inhibition rate and platelet activity before treatment and after 48 hours of treatment,total dosage of tirofiban,inflammatory response indexes(serum IL-6,TNF-αlevels)and National Institutes of Health Stroke Scale(NIHSS)score before treatment and after 14 days of treatment,modified Barthel Index(mBI)and modified Rankin Scale(mRS)score before treatment and at 3 months after treatment were compared between the two groups,and incidence of adverse events of the two groups was observed.Results There was no significant difference in platelet aggregation inhibition rate and platelet activity before treatment and after 48 hours of treatment or total dosage of tirofiban between the two groups(P>0.05).After 14 days of treatment,serum levels of IL-6,TNF-αand NIHSS score in the sequential group were lower than those in the intravenous group(P<0.05).At 3 months after treatment,mBI in the sequential group was higher than that in the intravenous group,and mRS score was lower than that in the intravenous group(P<0.05).There was no significant difference in the incidence of symptomatic intracranial hemorrhage transformation,non-symptomatic intracranial hemorrhage transformation or bleeding at other sites between the two groups(P>0.05).The incidence of vascular reocclusion in the sequential group w

关 键 词：缺血性脑卒中 超溶栓时间窗 替罗非班 动静脉序贯 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]