替罗非班治疗阿替普酶静脉溶栓后再闭塞的疗效观察

摘要

Objective To observe of the clinical efficacy and safety of tirofiban treatment in patients with early reocclusion after alteplase intravenous thrombolysis of acute ischemic stroke .Methods Patients with early reocclusion after were treated with alteplase intravenous thrombolysis within 4.5 hours of onset ,60 patients which were reocclusion after alteplase intravenous throm-bolysis ,were randomly divided into Group A (n=30) and Group B (n=30) .The patients in group B received tirofiban treatment (tirofiban was bolus injected with 5μg/kg in 3 minutes then continued at a dosage of 0.075μg/kg body weight/min at least 24h ) and group A as control .National Institutes of Health stroke scale (NIHSS) score before intravenous thrombolysis ,neurologic symptoms aggravated ,24h ,7d ,the modified Rankin scale (mRS) score after intravenous thrombolysis 90d were observed ,the mor-tality ,symptomatic cerebral hemorrhage were observed .Results NIHSS score of two groups of patients before thrombolysis and after thrombolysis neurologic symptoms aggravated(reocclusion)NIHSS score in both groups ,there was no significant difference (P>0.05) .But after 24h ,7d ,NIHSS scores between the two groups were significantly different (P<0.05) .At 90d from onset , mRS≤2 in the two groups were significantly different(P<0.05) .The mortality rate in the two groups had no significant differ-ence(P>0.05) .Symptoms of cerebral hemorrhage rate in the two groups had no significant difference (P>0.05) .Conclusion Tirofiban treatment in patients with early reocclusion after alteplase intravenous thrombolysis of acute ischemic stroke were effica-cy and safety .%目的 观察替罗非班治疗急性缺血性脑卒中阿替普酶静脉溶栓后再闭塞的疗效及安全性.方法 发病4.5 h内急性缺血性脑卒中患者行阿替普酶静脉溶栓再闭塞的患者60例,随机于再闭塞后予以静脉泵入替罗非班治疗(首剂5μg/kg静脉推注3 min,续以0.075μg·kg-1·min-1静脉持续泵入24 h)30例(B组)及常规治疗30例(A组).观察2组溶栓前、溶栓后症状加重时及24 h、7 d时NIHSS评分,90 d改良Rankin量表(mRS)评分及病死率、症状性颅内出血的发生率.结果 溶栓前、溶栓后症状加重(再闭塞)时,2组NIHSS评分差异无统计学意义(P>0.05).24 h、7 d时NIHSS评分2组差异有统计学意义(P<0.05).90 d时mRS≤2分2组差异有统计学意义(P<0.05);2组病死率差异无统计学意义(P>0.05);2组症状性脑出血发生率差异无统计学意义(P>0.05).结论 替罗非班治疗急性缺血性脑卒中阿替普酶静脉溶栓后再闭塞是有效的、安全的.