替罗非班对预防小卒中静脉溶栓后血管再闭塞的研究
摘要
目的评价替罗非班对预防小卒中静脉溶栓后血管再闭塞的临床疗效及安全性。方法选择接受阿替普酶(rt-PA)静脉溶栓成功的小卒中患者,随机分为两组,观察组64例,溶栓后立即给予替罗非班抗血小板聚集治疗;对照组64例,给予阿替普酶静脉溶栓;两组均于溶栓后1 h给予降脂稳定斑块、开放侧支循环等常规治疗,监测发生再闭塞的时间,同时分别评价溶栓前、后及3个月后的NIHSS评分、mRs评分;不良事件以症状性颅内出血表示。结果 (1)观察组溶栓后血管再闭塞7例,发生率10.9%;对照组溶栓后血管再闭塞22例,发生率34.4%,且两组发生再闭塞时间主要集中于溶栓后24 h内;(2)观察组3个月的神经功能改善及远期预后均显著优于对照组;(3)两组不良事件发生率差异无统计学意义(P>0.05)。结论小卒中静脉溶栓成功后给予替罗非班能降低早期血管再闭塞的发生率,同时可以显著改善患者远期神经功能缺损状况,且不增加症状性颅内出血等不良事件的发生。
引文
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[7] 金鑫,潘雪微,奚振华,等.阿替普酶对28例急性缺血性小卒中的疗效评估[J].中国现代医生,2018,56(7):104-107.
[8] 施国文,林岩,金海峰,等.轻型急性缺血性卒中溶栓治疗的疗效及安全性研究[J].中风与神经疾病杂志,2018,35(7):599-602.
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[13] 脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,42(6):62-64.
[14] Wang Y,Wang Y,Zhao X.Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack[J].J Vasc Surg,2013,58(4):11-19.
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[17] Tian C,Cao X,Wang J.Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion:choice of therapeutic strategy according to underlying aetiological mechanism?[J].Stroke Vasc Neurol,2017,2(4):244-250.
[18] Jeon JS,Sheen SH,Kim HC.Re-endovascular recanalization for acute middle cerebral artery reocclusion after surgical embolectomy[J].Neurointern Surg,2014,6(3):e24.
[19] Srinivas BC,Patra S,Reddy B,et al.Reocclusion and stroke due to immediate plaque protrusion following endovascular treatment of carotid artery successfully treated with intra-arterial urokinase and stent in stent in a patient with Takayasu arteritis with severe disease of all arch vessels[J].Cardiovasc Interv Ther,2013,28(4):394-397.
[20] 张苗苗,毛雯,仝其广,等.缺血后适应对在体大鼠心肌缺血再灌注损伤的保护作用及其机制[J].中华心血管病杂志,2016,44(7):616-620.
[21] Lee JI,Gliem M,Gerdes G,et al.Safety of bridging antiplatelet therapy with the gpⅡb-Ⅲa inhibitor tirofiban after emergency stenting in stroke[J].PLoS One,2017,12(12):e0190218.
[22] 李坷,张继中,张钦昌.国产替罗非班在急性进展性脑梗死治疗中的应用[J].中国实用神经疾病杂志,2017,20(1):117-118.
[23] 罗亚玮,陈方,潘昱,等.血小板糖蛋白Ⅱb/Ⅲa受体拮抗药替罗非班的抗血小板以外作用[J].中国药房,2015,26(2):278-281.
[2] Feigin VL,Norrving B,Mensah GA.Global burden of stroke[J].Circ Res,2017,120(3):439-448.
[3] Zhou M,Wang H,Zhu J,et al.Cause-specific mortality for 240 causes in China during 1990 /2013:a systematic subnational analysis for the Global Burden of Disease Study 2013[J].Lancet,2016,387(10015):251-272.
[4] Li J,Wang L,Chao B,et al.Prevalence of stroke in China:an epidemiological study based on the National Stroke Screening Survey[J].Lancet,2015,386:S49.
[5] Kim GE,Yoon W,Kim SK,et al.Incidence and Clinical Significance of Acute Reocclusion after Emergent Angioplasty or Stenting for Underlying Intracranial Stenosis in Patients with Acute Stroke[J].AJNR Am J Neuroradiol 2016,37(9):1690-1695.
[6] 张建,付慧霄,孙艳军.应用R-TPA溶栓治疗脑梗死病人溶栓后血管再闭塞的临床特点[J].中国老年学杂志,2016,36(8):1868-1869.
[7] 金鑫,潘雪微,奚振华,等.阿替普酶对28例急性缺血性小卒中的疗效评估[J].中国现代医生,2018,56(7):104-107.
[8] 施国文,林岩,金海峰,等.轻型急性缺血性卒中溶栓治疗的疗效及安全性研究[J].中风与神经疾病杂志,2018,35(7):599-602.
[9] 蒋廷润.轻型(NIHSS≤4分)缺血性卒中静脉溶栓的效果及研究进展[J].世界最新医学信息文摘,2018,18(63):36-37.
[10] 贺茂林.急性脑梗死在不同情况下进行溶栓治疗的价值[C]//中华医学会,中华医学会神经病学分会.中国脑血管病大会2014论文汇编.北京:中华医学会,2014:1.
[11] 潘广芹,宁天江,张立侠,等.静脉溶栓治疗急性轻型缺血性卒中的效果[J/OL].河南医学研究,2018(16):1[2018-10-07].http://kns.cnki.net/kcms/detail/41.1180.R.20180910.1114.054.html.
[12] 邵晓.脑梗死溶栓后早期血管再闭塞的临床分析[J].中国医药指南,2012,10(19):137-138.
[13] 脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,42(6):62-64.
[14] Wang Y,Wang Y,Zhao X.Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack[J].J Vasc Surg,2013,58(4):11-19.
[15] 薛群.溶栓治疗急性脑梗塞研究进展[J].国外医学脑血管病分册,1997,5(4):225.
[16] 张建,付慧霄,孙艳军.应用R-TPA溶栓治疗脑梗死病人溶栓后血管再闭塞的临床特点[J].中国老年学杂志,2016,36(8):1868-1869.
[17] Tian C,Cao X,Wang J.Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion:choice of therapeutic strategy according to underlying aetiological mechanism?[J].Stroke Vasc Neurol,2017,2(4):244-250.
[18] Jeon JS,Sheen SH,Kim HC.Re-endovascular recanalization for acute middle cerebral artery reocclusion after surgical embolectomy[J].Neurointern Surg,2014,6(3):e24.
[19] Srinivas BC,Patra S,Reddy B,et al.Reocclusion and stroke due to immediate plaque protrusion following endovascular treatment of carotid artery successfully treated with intra-arterial urokinase and stent in stent in a patient with Takayasu arteritis with severe disease of all arch vessels[J].Cardiovasc Interv Ther,2013,28(4):394-397.
[20] 张苗苗,毛雯,仝其广,等.缺血后适应对在体大鼠心肌缺血再灌注损伤的保护作用及其机制[J].中华心血管病杂志,2016,44(7):616-620.
[21] Lee JI,Gliem M,Gerdes G,et al.Safety of bridging antiplatelet therapy with the gpⅡb-Ⅲa inhibitor tirofiban after emergency stenting in stroke[J].PLoS One,2017,12(12):e0190218.
[22] 李坷,张继中,张钦昌.国产替罗非班在急性进展性脑梗死治疗中的应用[J].中国实用神经疾病杂志,2017,20(1):117-118.
[23] 罗亚玮,陈方,潘昱,等.血小板糖蛋白Ⅱb/Ⅲa受体拮抗药替罗非班的抗血小板以外作用[J].中国药房,2015,26(2):278-281.