经动脉导管局部给予替罗非班对超出溶栓时间窗急性缺血脑卒中的疗效分析

摘要

目的 探讨经动脉导管局部给予替罗非班对超出溶栓时间窗急性缺血性脑卒中患者治疗的临床疗效.方法 选取2015年6月~2016年12月就诊于昌乐县人民医院神经介入科的85例急性缺血脑卒中患者,均为发病6 h~72 h 内入院,超出动静脉溶栓时间窗,随机将患者分为处理组和对照组.对照组进行常规去除自由基、脑细胞保护以及支持疗法,处理组在此基础上局部给予替罗非班.检测治疗前后美国国立卫生院卒中量表(NIHSS)、日常生活能力量表(ADL)及Barther指数.使用经颅多普勒超声检测基底动脉和双侧大脑中动脉血流情况.结果 治疗前,两组的评分无统计差异.治疗后,与对照组相比,替罗非班治疗组的NIHSS评分显著降低(2.45±0.67 vs. 3.79±0.75),P<0.05.与对照组相比,Fugl-Meyer与ADL评分显著升高,分别为68.21±6.24 vs. 40.49±5.12和63.25±5.84 vs. 46.52±5.41,P<0.05.与对照组相比,替罗非班治疗组的基底动脉、左右侧大脑中动脉的血流学指标显著升高,分别为35.27±5.16 vs. 23.63±4.12,68.94±5.21 vs. 49.56±5.37和63.68±6.11 vs. 49.88±6.38,P<0.05.结论经动脉导管局部给予替罗非班对于超出动静脉溶栓时间窗的急性脑梗死患者有一定的疗效.%Objective To investigate the clinical efficacy of tirofiban administered by transcatheter arterial catheterization in patients with acute ischemic stroke beyond thrombolysis time window. Methods 85 patients administrated into in the Department of Neurology, Changle County People 's Hospital with acute ischemic stroke from April 2015 to Dec 2016 were enrolled in the study. The patients were admitted to the hospital after 6 h to 72 h and passed the thrombolysis time window. They were randomly divided into treatment group and control group. The treatment group was treated with conventional free radicals, brain cell protection and supportive therapy. Tirofiban were given by arterial catheterization. The control group was routinely treated with free radicals, brain cell protection, and supportive therapy. NIHSS, ADL and Barther indices were measured before and after treatment. Transcranial Doppler ultrasonography was used to detect basilar artery and bilateral middle cerebral artery blood flow. Results There was no significant difference between the two groups before treatment. After treatment, the NIHSS score was significantly lower in the tirofiban-treated group (2.45±0.67 vs. 3.79±0.75,P<0.05) than those in the control group. Fugl-Meyer and ADL scores were significantly increased when comparing to control group (68.21±6.24 vs. 40.49±5.12 and 63.25±5.84 vs. 46.52±5.41,P<0.05). The blood flow indicators of basilar artery, left and right side of the middle cerebral artery in tirofiban-treated group were significantly increased when comparing to control group (35.27±5.16 vs. 23.63±4.12,68.94±5.21 vs. 49.56±5.37 and 63.68±6.11 vs. 49.88±6.38,respectively,P<0.05). Conclusion The local administration of tirofiban via arterial catheters has a significant effect on patients with acute cerebral infarction beyond the time window of arteriovenous thrombolysis.