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(Q1,Q3),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治疗后的血小板计数、颅内出血率、症状性颅内出血率及病死率的差异均无统计学意义(均P＞0.05).两前循环亚组、两后循环亚组患者的性别、年龄、治疗前NIHSS评分等基线资料的差异均无统计学意义(均P＞0.05).研究组中前循环亚组患者的血管再通率[85.29％(58/68)对比 69.35％(43/62)]、≤3 次取栓成功率[70.59％(48/68)对比 53.23％(33/62)]、有效再通率[63.24％(43/68)对比45.16％(28/62)]、预后良好率[73.53％(50/68)对比51.61％(32/62)]均较对照组中前循环亚组高,差异均有统计学意义(均P＜0.05);研究组中后循环亚组治疗后 48 h[(8.27±3.49)分对比(10.94±5.06)分]和 10 d[(6.85±3.48)分对比(9.17±4.97)分]的NIHSS评分均较对照组中后循环亚组低,治疗前后NIHSS评分差值[M(Q1,Q3),48 h与治疗前:7.00(5.00,9.50)分对比 4.00(0,8.00)分;10 d 与治疗前:9.00(5.50,10.00)分对比 7.00(3.00,10.00)分]、血管再通率[92.68％(38/41)对比 74.47％(35/47)]、≤3 次取栓成功率[87.80％(36/41)对比 70.21％(33/47)]、有效再通率[87.80％(36/41)对比 68.09％(32/47)]均较对照组中后循环亚组高,差异均有统计学意义(均P＜0.05).结论 替罗非班可有效降低机械取栓治疗大血管闭塞性脑梗死患者的NIHSS评分,提高血管再通率,有效改善患者预后;其用于前、后循环大血管闭塞的效果尚不完全一致,但均安全、有效.
Application effect analysis of tirofiban for mechanical thrombectomy in patients with acute large vessel occlusion cerebral infarction
Objective To explore the efficacy and safety of tirofiban for mechanical thrombectomy in patients with acute large vessel occlusion cerebral infarction.Methods The 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.Results There 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 scores at 48 h and 10 d after treatment(48 h:9.34±3.90 scoresvs.10.74±4.39 scores;10 d:8.22±4.25 scores vs.9.84±4.82 scores),and 48 h vascular re-occlusion rates[5.50％(6/109)vs.14.68％(16/109)]of patients in the study group were lower than those in the control group,and the difference of NIHSS scores before and after treatment[M(Q1,Q3),between 48 h and before treatment:6.00(4.00,8.00)scores vs.4.00(0,7.00)scores;between 10 d and before treatment:7.00(4.00,10.00)scores vs.6.00(0.50,9.00)scores],the vascular reocclusion rate[88.07％(96/109)vs.71.56％(78/109)],the success rate of ≤ 3-times thrombectomy[77.06％(84/109)vs.60.55％(66/109)],the effective reocclusion rate[72.48％(79/109)vs.55.05％(60/109)]and the good prognosis rate[71.56％(78/109)vs.56.88％(62/109)]were higher than those in the control group,and the differences were statistically significant(all P＜0.05).There were no significant differences in platelet count,intracranial hemorrhage rate,symptomatic intracranial hemorrhage rate and mortality between the two groups after treatment(all P＞0.05).There were no significant differences in gender,age,pre-treatment NIHSS scores and other baseline data between the two anterior circulation subgroups and the two posterior circulation subgroups(all P＞0.05).The vascular revascularization rate[85.29％(58/68)vs.69.35％(43/62)],the success rate of ≤3-times thrombectomy[70.59％(48/68)vs.53.23％(33/62)],the effective revascularization rate[63.24％(43/68)vs.45.16％(28/62)]and the good outcome rate[73.53％(50/68)vs.51.61％(32/62)]in the anterior circulation subgroup of the study group were higher than those in the control group,and the differences were statistically significant(all P＜0.05).The NIHSS scores in the posterior circulation subgroup of the study group was lower than that in the control group at 48 h:(8.27±3.49 scores vs.10.94±5.06 scores)and 10 d:6.85±3.48 scores vs.9.17±4.97 scores)after treatment,and the difference of NIHSS scores before and after treatment[M(Q1,Q3),between 48 h and before treatment:7.00(5.00,9.50)scores vs.4.00(0,8.00)scores;between 10 d and before treatment:9.00(5.50,10.00)scores vs.7.00(3.00,10.00)scores],rate of vascular recirculation[92.68％(38/41)vs.74.47％(35/47)],success rate of ≤3-times thrombectomy[87.80％(36/41)vs.70.21％(33/47)]and effective recirculation rate[87.80％(36/41)vs.68.09％(32/47)]were higher than those in the posterior circulation subgroup of the control group,the differences were statistically significant(all P＜0.05).Conclusions Tirofiban can effectively reduce the NIHSS scores in patients with mechanical thrombectomy of large blood vessel occlusion,increase the vascular revascularization rate,and effectively improve the prognosis of patients.The effect of the treatment for anterior and posterior circulation of large blood vessel occlusion is not completely consistent,while it seems safe and effective in both situations.
Brain infarctionTreatment outcomeTirofibanAcute large vessel occlusionMechanical thrombectomy
万方数据
