Efficacy and safety of early remedial application of tirofiban after intravenous thrombolysis in acute ischemic stroke
张之悦 1徐艳 2张蕾 1王爽 1黎逢光3
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作者信息
1. 430080 武汉科技大学附属普仁医院神经内科、武汉科技大学医学部医学院
2. 中部战区总医院药剂科
3. 武汉科技大学附属普仁医院神经内科
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摘要
目的 探讨静脉溶栓后出现早期神经功能恶化(Early neurological deterioration,END)补救性应用替罗非班的疗效及安全性.方法 回顾性纳入2020年1月-2023年3月就诊于武汉科技大学附属普仁医院的65例急性缺血性脑卒中(Acute ischemic stroke,AIS)行静脉溶栓的患者为研究对象,依据静脉溶栓后出现END时是否应用替罗非班分为观察组(n=27)及对照组(n=38);比较2组患者入院时、静脉溶栓后、END时和治疗后第24 h、7、14 d的美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分及静脉溶栓后第90天改良Rankin量表(Modified Rankin scale,mRS)评分,比较治疗前后平均血小板体积与淋巴细胞比值(Mean platelet volume to lymphocyte ratio,MPVLR)、中性粒细胞与淋巴细胞比值(Neutrophils to lymphocytes ratio,NLR)值,观察治疗期间颅内出血转化(Hemorrhagic transformation,HT)、其他系统出血及血小板减少等不良事件.结果 观察组治疗后第24 h、7、14 d NIHSS评分均低于对照组(P均＜0.05);观察组治疗后MPVLR较治疗前明显降低(P＜0.05),且治疗后MPVLR,NLR低于对照组(P＜0.05);观察组治疗后第90 d预后优于对照组(x2=6.292,P=0.012);2组出现HT、其他系统出血及用药后血小板减少的比例均无明显差异(P＞0.05).结论 静脉溶栓后出现END应用替罗非班能够改善患者的神经功能及远期预后,且具有较好的安全性.
Abstract
Objective To investigate the efficacy and safety of using tirofiban for remedial treatment of early neurological deterioration(END)after intravenous thrombolysis.Methods A retrospective study was conducted on 65 patients with acute ischemic stroke(AIS)who underwent intravenous thrombolysis at Puren Hospital from January 2020 to March 2023.They were divided into an observation group(n=27)and a con-trol group(n=38)based on whether tirofiban was used after the occurrence of neurological deterioration fol-lowing thrombolysis.The National Institute of Health Stroke Scale(NIHSS)was compared between the two groups at admission,after intravenous thrombolysis,during neurological deterioration,and at 24 h,7 h,and 14 d post-treatment.Additionally,the modified Rankin scale(mRS)score at 90 d after intravenous thrombol-ysis was also compared between the two groups.The mean platelet volume-to-lymphocyte ratio(MPVLR)and neutrophil-to-lymphocyte ratio(NLR)levels were compared before and after treatment.Adverse events such as intracranial hemorrhagic transformation(HT),other systemic bleeding,and platelet reduction were ob-served during the treatment period.Results The observation group obtained lower NIHSS scores at 24 h,7,and 14 d after treatment compared to those of the control group(P＜0.05).The MPVLR significantly de-creased after tirofiban treatment in the observation group(P＜0.05),and both the MPVLR and NLR were lower in the observation group than in the control group(P＜0.05).The prognosis of the observation group at 90 d was better than the control group(x2=6.292,P=0.012).No significant difference was detected in the incidence of bleeding events and platelet reduction between the two groups(P＞0.05).Conclusion The tirofi-ban treatment after intravenous thrombolysis in patients experiencing early neurological deterioration enhances their neurological function and long-term prognosis while maintaining a favorable safety profile.
维普
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