替罗非班治疗阿替普酶静脉溶栓后再闭塞的疗效观察
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摘要
目的观察替罗非班治疗急性缺血性脑卒中阿替普酶静脉溶栓后再闭塞的疗效及安全性。方法发病4.5h内急性缺血性脑卒中患者行阿替普酶静脉溶栓再闭塞的患者60例,随机于再闭塞后予以静脉泵入替罗非班治疗(首剂5μg/kg静脉推注3min,续以0.075μg·kg~(-1)·min~(-1)静脉持续泵入24h)30例(B组)及常规治疗30例(A组)。观察2组溶栓前、溶栓后症状加重时及24h、7d时NIHSS评分,90d改良Rankin量表(mRS)评分及病死率、症状性颅内出血的发生率。结果溶栓前、溶栓后症状加重(再闭塞)时,2组NIHSS评分差异无统计学意义(P>0.05)。24h、7d时NIHSS评分2组差异有统计学意义(P<0.05)。90d时mRS≤2分2组差异有统计学意义(P<0.05);2组病死率差异无统计学意义(P>0.05);2组症状性脑出血发生率差异无统计学意义(P>0.05)。结论替罗非班治疗急性缺血性脑卒中阿替普酶静脉溶栓后再闭塞是有效的、安全的。
Objective To observe of the clinical efficacy and safety of tirofiban treatment in patients with early reocclusion after alteplase intravenous thrombolysis of acute ischemic stroke.Methods Patients with early reocclusion after were treated with alteplase intravenous thrombolysis within 4.5 hours of onset,60 patients which were reocclusion after alteplase intravenous thrombolysis,were randomly divided into Group A(n=30)and Group B(n=30).The patients in group B received tirofiban treatment(tirofiban was bolus injected with 5μg/kg in 3 minutes then continued at a dosage of 0.075μg/kg body weight/min at least 24 h)and group A as control.National Institutes of Health stroke scale(NIHSS)score before intravenous thrombolysis,neurologic symptoms aggravated,24 h,7 d,the modified Rankin scale(mRS)score after intravenous thrombolysis 90 dwere observed,the mortality,symptomatic cerebral hemorrhage were observed.Results NIHSS score of two groups of patients before thrombolysis and after thrombolysis neurologic symptoms aggravated(reocclusion)NIHSS score in both groups,there was no significant difference(P>0.05).But after 24 h,7 d,NIHSS scores between the two groups were significantly different(P<0.05).At 90 dfrom onset,mRS≤2 in the two groups were significantly different(P <0.05).The mortality rate in the two groups had no significant difference(P>0.05).Symptoms of cerebral hemorrhage rate in the two groups had no significant difference(P>0.05).Conclusion Tirofiban treatment in patients with early reocclusion after alteplase intravenous thrombolysis of acute ischemic stroke were efficacy and safety.
Objective To observe of the clinical efficacy and safety of tirofiban treatment in patients with early reocclusion after alteplase intravenous thrombolysis of acute ischemic stroke.Methods Patients with early reocclusion after were treated with alteplase intravenous thrombolysis within 4.5 hours of onset,60 patients which were reocclusion after alteplase intravenous thrombolysis,were randomly divided into Group A(n=30)and Group B(n=30).The patients in group B received tirofiban treatment(tirofiban was bolus injected with 5μg/kg in 3 minutes then continued at a dosage of 0.075μg/kg body weight/min at least 24 h)and group A as control.National Institutes of Health stroke scale(NIHSS)score before intravenous thrombolysis,neurologic symptoms aggravated,24 h,7 d,the modified Rankin scale(mRS)score after intravenous thrombolysis 90 dwere observed,the mortality,symptomatic cerebral hemorrhage were observed.Results NIHSS score of two groups of patients before thrombolysis and after thrombolysis neurologic symptoms aggravated(reocclusion)NIHSS score in both groups,there was no significant difference(P>0.05).But after 24 h,7 d,NIHSS scores between the two groups were significantly different(P<0.05).At 90 dfrom onset,mRS≤2 in the two groups were significantly different(P <0.05).The mortality rate in the two groups had no significant difference(P>0.05).Symptoms of cerebral hemorrhage rate in the two groups had no significant difference(P>0.05).Conclusion Tirofiban treatment in patients with early reocclusion after alteplase intravenous thrombolysis of acute ischemic stroke were efficacy and safety.
引文
[1]ALEXANDROV A V,GROTTA J C.Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator[J].Neurology,2002,59(6):862-867.
[2]RUBIERA M,ALVAREZ-SABIN J,RIBO M,et al.Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke[J].Stroke,2005,36(7):1 452-1 456.
[3]高俊杰,许雯蔚,陈湛愔,等.脑梗死出血性转化的危险因素分析[J].中华脑科疾病与康复杂志(电子版),2016,6(3):129-135.
[4]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]吴瑞,李海军,刘胜武,等.重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的疗效[J].贵州医科大学学报,2017,(6):699-702.
[6]AGIS D,GOGGINS M B,OISHI K,et al.Picturing the Size and Site of Stroke With an Expanded National Institutes of Health Stroke Scale[J].Stroke,2016,47(6):1459-1 465.
[7]胡淑梅,张利焕,张爽.阿替普酶静脉溶栓治疗急性缺血性脑卒中患者的临床疗效及其安全性[J].临床合理用药杂志,2017,10(3):7-8;11.
[8]李燕宏,刘爱东.阿替普酶治疗急性脑梗死患者的临床研究及机制[J].西南军医,2016,18(5):411-414.
[9]朱立勋,耿瑞慧,陆学胜,等.急性脑梗死阿替普酶静脉溶栓后血管再闭塞应用低分子肝素钙的价值[J].武警医学,2015,26(6):555-557;562.
[10]李德奎,刘跃,朱清红,等.脑梗死患者同型半胱氨酸、凝血功能、血小板参数和血液流变学指标检测的临床意义[J].国际检验医学杂志,2014,35(10):1 275-1276;1 279.
[11]何来鹏,王欣.脑梗死急性期患者血小板膜GPⅡb/Ⅲa复合物和P-选择素的表达[J].广东医学院学报,2014,32(4):462-463.
[12]LAN X,HAN X,LI Q,et al.Modulators of microglial activation and polarization after intracerebral haemorrhage[J].Nat Rev Neurol,2017,13(7):420-433.
[13]王利军,王建平,李楠,等.血清TGF1水平与急性脑梗死侧支循环及预后相关性分析[J].中国实用神经疾病杂志,2017,20(17):1-3.
[14]YUAN Q Z,YAN J Z,HAI L R,et al.Safety of tirofiban for patients with acute ischemic stroke in routine clinical practice[J].Exp Ther Med,2015,10(1):169-174.
[15]LI Q,HAN X,LAN X,et al.Inhibition of tPA-induced hemorrhagic transformation involves adenosine A2breceptor activation after cerebral ischemia[J].Neurobiol Dis,2017,108:173-182.
[16]LEI F,JUN L,YUN L,et al.Safety of tirofiban for patients with acute ischemic stroke in routine clinical practice[J].Exp Ther Med,2016,11(3):1 011-1 016.
[17]MRDOVIC I,SAVIC L,LASICA R,et al.Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel:results of propensity analysis using the Clinical Center of Serbia STEMI Register[J].Eur Heart J Acute Cardiovasc Care,2014,3(1):56-66.
[18]NAZIF T M,MEHRAN R,LEE E A,et al.Comparative effectiveness of upstream glycoprotein IIb/IIIa inhibitors in patients with moderate-and high-risk acute coronary syndromes:an Acute Catheterization and Urgent Intervention Triage Strategy(ACUITY)substudy[J].Am Heart J,2014,167(1):43-50.
[19]KAYMAZ C,KELES N,OZDEMIR N,et al.The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI[J].Anatol J Cardiol,2015,15(11):899-906.
[20]CICCONE A,MOTTO C,ABRAHA I,et al.Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke[J].Cochrane Database Syst Rev,2014,(3):208-214.
[2]RUBIERA M,ALVAREZ-SABIN J,RIBO M,et al.Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke[J].Stroke,2005,36(7):1 452-1 456.
[3]高俊杰,许雯蔚,陈湛愔,等.脑梗死出血性转化的危险因素分析[J].中华脑科疾病与康复杂志(电子版),2016,6(3):129-135.
[4]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]吴瑞,李海军,刘胜武,等.重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的疗效[J].贵州医科大学学报,2017,(6):699-702.
[6]AGIS D,GOGGINS M B,OISHI K,et al.Picturing the Size and Site of Stroke With an Expanded National Institutes of Health Stroke Scale[J].Stroke,2016,47(6):1459-1 465.
[7]胡淑梅,张利焕,张爽.阿替普酶静脉溶栓治疗急性缺血性脑卒中患者的临床疗效及其安全性[J].临床合理用药杂志,2017,10(3):7-8;11.
[8]李燕宏,刘爱东.阿替普酶治疗急性脑梗死患者的临床研究及机制[J].西南军医,2016,18(5):411-414.
[9]朱立勋,耿瑞慧,陆学胜,等.急性脑梗死阿替普酶静脉溶栓后血管再闭塞应用低分子肝素钙的价值[J].武警医学,2015,26(6):555-557;562.
[10]李德奎,刘跃,朱清红,等.脑梗死患者同型半胱氨酸、凝血功能、血小板参数和血液流变学指标检测的临床意义[J].国际检验医学杂志,2014,35(10):1 275-1276;1 279.
[11]何来鹏,王欣.脑梗死急性期患者血小板膜GPⅡb/Ⅲa复合物和P-选择素的表达[J].广东医学院学报,2014,32(4):462-463.
[12]LAN X,HAN X,LI Q,et al.Modulators of microglial activation and polarization after intracerebral haemorrhage[J].Nat Rev Neurol,2017,13(7):420-433.
[13]王利军,王建平,李楠,等.血清TGF1水平与急性脑梗死侧支循环及预后相关性分析[J].中国实用神经疾病杂志,2017,20(17):1-3.
[14]YUAN Q Z,YAN J Z,HAI L R,et al.Safety of tirofiban for patients with acute ischemic stroke in routine clinical practice[J].Exp Ther Med,2015,10(1):169-174.
[15]LI Q,HAN X,LAN X,et al.Inhibition of tPA-induced hemorrhagic transformation involves adenosine A2breceptor activation after cerebral ischemia[J].Neurobiol Dis,2017,108:173-182.
[16]LEI F,JUN L,YUN L,et al.Safety of tirofiban for patients with acute ischemic stroke in routine clinical practice[J].Exp Ther Med,2016,11(3):1 011-1 016.
[17]MRDOVIC I,SAVIC L,LASICA R,et al.Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel:results of propensity analysis using the Clinical Center of Serbia STEMI Register[J].Eur Heart J Acute Cardiovasc Care,2014,3(1):56-66.
[18]NAZIF T M,MEHRAN R,LEE E A,et al.Comparative effectiveness of upstream glycoprotein IIb/IIIa inhibitors in patients with moderate-and high-risk acute coronary syndromes:an Acute Catheterization and Urgent Intervention Triage Strategy(ACUITY)substudy[J].Am Heart J,2014,167(1):43-50.
[19]KAYMAZ C,KELES N,OZDEMIR N,et al.The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI[J].Anatol J Cardiol,2015,15(11):899-906.
[20]CICCONE A,MOTTO C,ABRAHA I,et al.Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke[J].Cochrane Database Syst Rev,2014,(3):208-214.