盐酸替罗非班氯化钠注射液治疗卒中预警综合征的疗效观察
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摘要
目的探讨盐酸替罗非班氯化钠注射液治疗卒中预警综合征的有效性及安全性。方法 2015-01—2018-03沈阳维康医院收治卒中预警综合征患者12例,给予盐酸替罗非班氯化钠注射液治疗。另收集2010-01—2014-12治疗的卒中预警综合征患者10例为对照组,给予阿司匹林及氯吡格雷双联抗血小板聚集治疗。观察2组患者用药后TIA样症状出现率、脑梗死转化率、出院时NIHSS评分、3个月后mRS评分及不良事件发生率。结果研究组TIA样症状出现率明显低于对照组(P<0.05),末次症状出现时间也明显少于对照组(P<0.05)。研究组进展为急性脑梗死的比率41.7%,对照组为90%,研究组明显低于对照组(P=0.031)。研究组出院时NIHSS评分(3.11±4.72)分,明显低于对照组的(7.93±5.21)分(P<0.05)。研究组患者3个月后mRS评分(0.64±1.99)分,明显优于对照组的(3.15±1.72)分。2组均未出现症状性颅内出血、其他部位出血及死亡患者。结论替罗非班能够有效控制卒中预警综合征患者的临床发作,显著缩短持续发作时间,能够有效减少演化为急性脑梗死的患者比率,改善卒中预警综合征患者神经功能缺损及远期临床预后,改善生活质量,安全性良好。
Objective To investigate the efficacy and safety of tirofiban hydrochloride and sodium chloride injection in the treatment of stroke warning syndrome.Methods A total of 12 patients with stroke warning syndrome treated from January 2015 to March 2018 were treated with tirofiban hydrochloride and sodium chloride injection.A total of 10 patients with stroke warning syndrome treated in this department from January 2010 to December 2014 were collected as control group.Patients in control group were treated with aspirin-clopidogrel anti-platelet aggregation.The incidence rate of TIA-like symptoms,conversion rate of cerebral infarction,NIHSS score at discharge,mRS score after 3 months and incidence rate of adverse reactions were compared between the two groups of patients.Results In research group,the incidence rate of TIA-like symptoms was significantly lower than that in control group(P<0.05),and the onset time of the last symptom was significantly shorter than that in control group(P<0.05).The rate of acute cerebral infarction in research group(41.7%) was obviously lower than that in control group(90%)(P=0.031).The NIHSS score at discharge was(3.11±4.72) points in research group,remarkably lower than that in control group(7.93±5.21)(P<0.05).The mRS score after 3 months was(0.64±1.99) points in research group,significantly superior to that in control group(3.15±1.72).No symptomatic intracranial hemorrhage,hemorrhage in other sites and death occurred in both groups.Conclusion Tirofiban can effectively control the clinical attack,shorten the duration of attack significantly,dramatically reduce the ratio of patients suffering from acute cerebral infarction,effectively improve the neurological deficit and long-term clinical prognosis,and increase the quality of life of patients with stroke warning syndrome,which has good safety.
Objective To investigate the efficacy and safety of tirofiban hydrochloride and sodium chloride injection in the treatment of stroke warning syndrome.Methods A total of 12 patients with stroke warning syndrome treated from January 2015 to March 2018 were treated with tirofiban hydrochloride and sodium chloride injection.A total of 10 patients with stroke warning syndrome treated in this department from January 2010 to December 2014 were collected as control group.Patients in control group were treated with aspirin-clopidogrel anti-platelet aggregation.The incidence rate of TIA-like symptoms,conversion rate of cerebral infarction,NIHSS score at discharge,mRS score after 3 months and incidence rate of adverse reactions were compared between the two groups of patients.Results In research group,the incidence rate of TIA-like symptoms was significantly lower than that in control group(P<0.05),and the onset time of the last symptom was significantly shorter than that in control group(P<0.05).The rate of acute cerebral infarction in research group(41.7%) was obviously lower than that in control group(90%)(P=0.031).The NIHSS score at discharge was(3.11±4.72) points in research group,remarkably lower than that in control group(7.93±5.21)(P<0.05).The mRS score after 3 months was(0.64±1.99) points in research group,significantly superior to that in control group(3.15±1.72).No symptomatic intracranial hemorrhage,hemorrhage in other sites and death occurred in both groups.Conclusion Tirofiban can effectively control the clinical attack,shorten the duration of attack significantly,dramatically reduce the ratio of patients suffering from acute cerebral infarction,effectively improve the neurological deficit and long-term clinical prognosis,and increase the quality of life of patients with stroke warning syndrome,which has good safety.
引文
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[3] MUENGTAWEEPONGSA S,SINGH N N,CRUZFLORES S.Pontine warning syndrome:case series and review of literature[J].J Stroke Cerebrovasc Dis,2010,19(5):353-356.
[4] NANDHAGOPAL R,ALASMI A,JOHNSTON W J,et al.Callosal warning syndrome[J].J Neurol Sci,2012,314(1/2):178-180.
[5] 孙亚楠,滕继军,孙凤娇.内囊预警综合征[J].国际脑血管病杂志,2013,21(12):928-932.
[6] 曲长海,王广田,曲方.卒中预警综合征研究进展[J].医学综述,2015,21(3):492-494.
[7] SPRINGER M V,LABOVITZ D L.The capsular warning syndrome reconsidered[J].Cerebrovasc Dis,2013,36(2):152.
[8] PAUL N L,SIMONI M,CHANDRATHEVA A,et al.Population-based study of capsular warning syndrome and prognosis after early recurrent TIA[J].J Vasc Surg,2013,57(1):1 356-1 362.
[9] LALIVE P H,MAYOR I,SZTAJZEL R.The Role of Blood Pressure in Lacunar Strokes Preceded by TIAs[J].Cerebrovasc Dis,2003,16(1):88-90.
[10] BENE A D,PALUMBO V,LAMASSA M,et al.Progressive lacunar stroke:Review of mechanisms,prognostic features,and putative treatments[J].Int J Stroke,2012,7(4):321.
[11] ASIL T,IR N,KARADUMAN F,et al.Combined antithrombotic treatment with aspirin and clopidogrel for patients with capsular warning syndrome:a case report[J].Neurologist,2012,18(2):68.
[12] CHATZIKONSTANTINOU A,WILLMANN O,J?GER T,et al.Transient ischemic attack patients with fluctuations are at highest risk for early stroke[J].Cerebrovasc Dis,2009,27(6):594.
[13] 孙钦建,郑兴月,屈传强.替罗非班在缺血性卒中溶栓和血管内治疗中的应用[J].国际脑血管病杂志,2014,22(8):620-624.
[14] KRAFT P,SCHUHMANN M K,FLURI F,et al.Efficacy and Safety of Platelet Glycoprotein Receptor Blockade in Aged and Comorbid Mice With Acute Experimental Stroke[J].Stroke,2015,46(12):3 502-3 506.
[15] LI W,LIN L,ZHANG M,et al.Safety and Preliminary Efficacy of Early Tirofiban Treatment After Alteplase in Acute Ischemic Stroke Patients[J].Stroke,2016,47(10):2 649.
[16] 孙原,石秋艳,李艳玲,到.替罗非班治疗阿替普酶静脉溶栓后再闭塞的疗效观察[J].中国实用神经疾病杂志,2018,21(1):40-43.
[17] 杨直堂,苏进营,刘志军,等.替罗非班在脑梗死不同时期的安全性及对血小板活化的影响[J].中国实用神经疾病杂志,2018,21(20):2 217-2 221.
[18] YANG M,HUO X,MIAO Z,et al.Platelet Glycoprotein IIb/IIIa ReceptorInhibitor Tirofiban in Acute Ischemic Stroke[J].Drugs,2019,79(5):515-529.DOI:10.1007/s40265-019-01078-0.
[19] NIU J,DING Y,ZHAI T,et al.Theefficacy and safety of tirofiban for patients with acute ischemic stroke:Aprotocol for systematic review and a meta-analysis[J].Medicine (Baltimore),2019,98(9):e14673.DOI:10.1097/MD.0000000000014673.
[20] PAN X,ZHENG D,ZHENG Y,et al.Safety andefficacy of tirofiban combined with endovascular treatment in acute ischaemicstroke[J].Eur J Neurol,2019.DOI:10.1111/ene.13946.
[21] LIU J,SHI Q,SUN Y,et al.Efficacy of TirofibanAdministered at Different Time Points after Intravenous Thrombolytic Therapy withAlteplase in Patients with Acute Ischemic Stroke[J].J Stroke Cerebrovasc Dis,2019,28(4):1 126-1 132.DOI:10.1016/j.jstrokecerebrovasdis.2018.12.044.
[22] ZHANG S,HAO Y,TIAN X,et al.Safety of Intra-Arterial TirofibanAdministration in Ischemic Stroke Patients after Unsuccessful MechanicalThrombectomy[J].J Vasc Interv Radiol,2019,30(2):141.e1-147.e1.DOI:10.1016/j.jvir.2018.08.021.
[23] ANDERSON G L,OSBORN J L,NEI S D,et al.Comparison of In-Hospital Bleeding and Cardiovascular Events with High-Dose BolusTirofiban and Shortened Infusion to Short-Duration Eptifibatide as AdjunctiveTherapy for Percutaneous Coronary Intervention[J].Am J Cardiol,2019,123(1):44-49.DOI:10.1016/j.amjcard.2018.09.029.
[24] GRUBER P,HLAVICA M,BERBERAT J,et al.Acute administration of tirofiban versus aspirin in emergentcarotid artery stenting[J].Interv Neuroradiol,2019,25(2):219-224.DOI:10.1177/1591019918808777.
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