替罗非班在急性脑梗死支架取栓术中的临床应用-现代医学

替罗非班在急性脑梗死支架取栓术中的临床应用

单位：陕西省人民医院神经内一科, 陕西西安 710068

分类号：R743.33

出版年·卷·期（页码）：2017·36·第九期（1247-1252）

摘要：

目的：探讨替罗非班应用于急性脑梗死支架取栓术中的临床疗效及安全性。方法：回顾性分析2014年1月至2016年12月因急性前循环脑梗死行SolitareAB支架取栓治疗患者的临床资料，共63例，设为替罗非班组。其中29例患者行单纯支架取栓治疗，设为单纯支架取栓组；34例患者在取栓治疗过程中应用了替罗非班，经过1次支架取栓血管不通或再通不良，再次将SolitaireAB支架打开后经动脉鞘管注射替罗非班（8 μg·kg^-1，3 min推完）负荷量，继续静脉泵入替罗非班24 h （0.1 μg·kg^-1·min^-1）。采用改良心肌梗死溶栓试验（mTICI）血流分级评估两组术后血流灌注情况；对比两组术前、术后24 h、术后2周的NIHSS评分；比较两组术后症状性出血的发生率；采用改良的Rankin评定量表统计患者3个月后mRS评分。结果：给予替罗非班后，mTICI血流分级提高，mTICI 3级血流获得率明显高于单纯支架取栓组（P<0.05）；两组术后24 h的NIHSS评分较术前明显改善（P<0.05）；术后24 h两组之间NIHSS评分比较差异无统计学意义（P>0.05）；术后2周NIHSS评分替罗非班组较单纯支架取栓组改善明显（P<0.05）；3个月后mRS评分替罗非班组较单纯支架取栓组改善明显（P<0.05），两组症状性出血率无明显差异（P>0.05）。结论：SolitaireAB支架取栓过程中给予替罗非班可提高前向血流mTICI分级，改善脑灌注，减轻临床症状，提高患者生活质量，不增加出血风险。

Objective: To investigate the clinical efficacy and safety of tirofiban in stent thrombectomy for acute cerebral infarction. Methods: Clinical data of 63 patients with acute anterior circulation infarction undergoing treatment of solitare AB stent thrombectomy from January 2014 to December 2016 were retrospectively analysed, and they were divided into simple stent thrombectomy group and tirofiban group. 29 patients in simple stent thrombectomy group were treated with simple stent thrombectomy, and 34 patients in tirofiban group were treated with tirofiban during thrombectomy[The solitaireAB stent was opened again when vascular obstruction or recanalization after first stent thrombectomy and tirofiban load(8 μg·kg^-1, 3 min) was injected via the arterial sheath tube, after that tirofiban was continuouslypumped 24 h intravenously(0.1 μg·kg^-1·min^-1)]. Postoperative blood perfusion of the two groups was evaluated by mTICI blood flow fractionation. The NIHSS score before operation, 24 hours and 2 weeks after operation and the incidence of symptomatic bleedingafter operation were compared between the two groups. The modified Rankin rating scale was used to calculate the mRS score after 3 months. Results: The mTICI blood flow fractionation was increased after tirofiban treatmentand the rate of mTICI 3 stage blood flow of tirofiban group was significantly higher than that of the single embolectomy group (P<0.05). The NIHSS score of postoperative 24 hours in two groups was significantly improved compared with that before operation(P<0.05). There was no significant difference in NIHSS score of postoperative 24 hours between the two groups(P>0.05). The NIHSS score of 2 weeks after operation was significantly improved in the tirofiban group compared with that in the single embolectomy group (P<0.05).The mRS score was significantly improved in the tirofiban group compared with that in the simple stent thrombectomy group after 3 months (P<0.05). There was no significant difference in the symptomatic bleeding rate between the two groups (P>0.05). Conclusion: Administration of tirofiban during the thrombectomy of SolitaireAB stent can improve the mTICI fractionation of the anterior cerebral blood flow and cerebral perfusion, reduce clinical symptoms, enhance the quality of life of patients, and do not increase the risk of bleeding.

参考文献：

[1] 梁国标.积极稳妥地开展急性缺血性卒中的血管内治疗[J].中国微侵袭神经外科杂志,2015,20(1):1-3.
[2] CICCONE A,VALVASSORI L,NICHELATTI M,et al.Endovascular treatment for acute ischemic stroke[J].N Engl J Med,2013,368(10):904-913.
[3] SAVER J L,JAHAN R,LEVY E I,et al.Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke(SWIFT):a randomised,parallel-group,non inferiority trial[J].Lancet,2012,380(9849):1241-1249.
[4] GIORDANO A,D'ANGELILLO A,ROMANO S,et al.Tirofiban induces VEGF production and stimulates migration and proliferation of endothelial cells[J].Vascul Pharmacol,2014,61:63-71.
[5] ZAIDAT O O,YOO A J,KHATRI P,et al.Recommendations onangiographic revascularization grading standards for acute ischemic stroke:a consensus statement[J].Stroke,2013,44(9):2650-2663.
[6] 中华预防医学会卒中预防与控制专业委员会介入学组,急性缺血性脑卒中血管内治疗中国专家共识组.急性缺血性脑卒中血管内治疗中国专家共识[J].中国脑血管病杂志,2014,11(10):556-560.
[7] ABUL-KASIMK,BRIZZIM,PETERSSONJ.Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow[J].Acta Neurol Scand,2010,122(2):132-139.
[8] RIEDEL C H,ZIMMERMANN P,JENSEN-KONDERING U,et al.The importance of size:successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length[J].Stroke,2011,42(6):1775-1777.
[9] BREKENFELD C,SCHROTH G,MORDASINI P,et al.Impact of retrievable stents on acute ischemic stroke treatment[J].Am J Neuroradiol,2011,32(7):1269-1273.
[10] SAVER J L,JAHAN R,LEVY E I,et al.Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT):a randomised,parallel-group,non-inferiority trial[J].Lancet,2012,380(9849):1241-1249.
[11] 屈洋,王君升,王智,等.Solitaire AB支架取栓治疗急性缺血性脑卒中[J].中国微侵袭神经外科杂志,2016,21(4):163-164.
[12] 胡昔奇,夏鹰.急性缺血性脑卒中机械性取栓研究进展[J].中国老年学杂志,2016,35:5023-5025.
[13] KURRE W,PEREZ M A,HORVATH D,et al.Does mechanicalthrombectomy in acute embolic stroke have long-term side effects on intracranial vessels?An angiographic follow-up study[J].Cardiovasc Intervent Radiol,2013,36(3):629-636.
[14] BERKHEMER O A,FRANSEN P S,BEUMER D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].N Engl J Med,2015,372:11-20.
[15] CAMPBELL B C,MITCHELL P J,KLEINIG T J,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl J Med,2015,372:1009-1018.
[16] 中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015,10(7):590-606.
[17] 秦华.新型血小板GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班[J].中国新药杂志,2002,11(3):197-200.
[18] 尤威,贾海波,叶飞,等.经微导管冠脉内注射替罗非斑治疗超高龄患者急性ST段抬高型心肌梗死的疗效[J].东南大学学报:医学版,2015,34(6):953-958.
[19] 周发展,武君,张春玲,等.替罗非班应用于急诊经皮冠状动脉介入治疗对急性心肌梗死患者心肌灌注和内皮功能的影响[J].中华危重症医学杂志:电子版,2016,9(1):3-7.
[20] 梁晓东,王子亮,李天晓,等.替罗非班在颅内破裂动脉瘤介入治疗术中预防性应用研究[J].介入放射学杂志,2015,24(12):1034-1038.
[21] 刘加春,刘玲,王大明,等.替罗非班在支架辅助栓塞颅内动脉瘤中的初步应用[J].中国脑血管病杂志,2012,9(4):189-193.
[22] 刘小洲.替罗非班治疗进展性脑梗死的疗效及安全性评估[J].中国医院医药杂志,2014,34(18):1600-1603.
[23] SEO J H,JEONG H W,KIM S T,et al.Adjuvant tirofiban injection through deployed solitaire stent as a rescue technique after failed mechanical thrombectomy in acute stroke[J].Neurointervention,2015,10(1):22-27.
[24] GOH D H,JIN S C,JEONG H W,et al.Mechanical solitaire thrombectomy with low-dose booster tirofiban injection[J].Neurointervention,2016,11(2):114-119.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录