替罗非班治疗超时间窗前循环大动脉粥样硬化型急性脑梗死的疗效观察

目的 探讨静脉应用替罗非班注射液治疗超时间窗前循环大动脉粥样硬化型急性脑梗死患者的疗效。方法 选取2021年11月至2022年12月入住温州市中心医院神经内科的前循环大动脉粥样硬化型急性脑梗死患者66例为研究对象，采用随机数字表法将其分为治疗组和对照组，每组各33例。对照组患者予阿司匹林肠溶片；治疗组患者予静脉泵入替罗非班注射液维持48h，再桥接常规抗血小板治疗，疗程均为2周，后续随访6个月。比较治疗前后两组患者的美国国立卫生研究院卒中量表（National Institutes of Health stroke scale，NIHSS）评分、改良Rankin量表（modified Rankin scale，MRS）评分、改良Barthel指数（modified Barthel index，MBI）评分、血栓弹力图、脑梗死出血转化情况。结果 治疗14d，治疗组患者的NIHSS评分显著低于治疗前（P<0.01），且显著低于对照组（P<0.05）；治疗14d和随访6个月，两组患者的MRS评分均显著低于本组治疗前（P<0.01）；随访6个月，治疗组患者的MRS评分显著低于对照组（P<0.05）；治疗7d、14d，随访6个月，治疗组患者的MBI评分均显著高于本组治疗前（P<0.05）；治疗14d、随访6个月，治疗组患者的MBI均显著高于对照组（P<0.05）；治疗后，治疗组患者的血小板聚集抑制率显著高于对照组（P<0.01），血小板活性显著低于对照组（P<0.01）；两组患者均无脑梗死出血转化情况发生。结论 替罗非班桥接常规抗血小板治疗可阻止急性脑梗死的神经功能缺损恶化，大大降低致残率，改善患者的生活能力，且不增加脑出血风险。

Efficacy of tirofiban in treatment of acute cerebral infarction beyond the time window and with the type of anterior circulation artery atherosclerosis

Objective To evaluate the efficacy of tirofiban injection in treatment of acute cerebral infarction beyond the time window and with the type of anterior circulation artery atherosclerosis. Methods A total of 66 patients with acute cerebral infarction with the type of anterior circulation artery atherosclerosis admitted to the Department of Neurology of Wenzhou Central Hospital from November 2021 to December 2022 were selected as study objects, and they were divided into treatment group and control group by random number table method, with 33 cases in each group. The control group was given aspirin enteric-coated tablets. The treatment group was given intravenous infusion of tirofiban injection for 48 hours, bridging conventional antiplatelet therapy. The course of treatment was 2 weeks and the follow-up was 6 months. Before and after treatment, National Institutes of Health stroke scale (NIHSS) score, modified Rankin scale (MRS) score, modified Barthel index (MBI) score, thromboelasmogram and cerebral infarction hemorrhage transformation of two groups were compared. Results After 14 days of treatment, the NIHSS score in treatment group was significantly lower than before treatment (P<0.01), and significantly lower than that in control group (P<0.05). After 14 days of treatment and 6 months of follow-up, MRS scores in both groups were significantly lower than before treatment (P<0.01). After 6 months of follow-up, MRS scores in treatment group were significantly lower than those in control group (P<0.05). After 7 and 14 days of treatment and 6 months of follow-up, the MBI scores of patients in treatment group were significantly higher than before treatment (P<0.05). After 14 days of treatment and 6 months of follow-up, MBI scores in treatment group were significantly higher than those in control group (P<0.05). After treatment, the platelet aggregation inhibition rate in treatment group was significantly higher than that in control group (P<0.01), and the platelet activity was significantly lower than that in control group (P<0.01). No cerebral infarction hemorrhage transformation occurred in both groups. Conclusion Tirofiban bridging conventional antiplatelet therapy can prevent the neurological deterioration of acute cerebral infarction, greatly reduce the rate of disability, improve patients’ life ability, and do not increase the risk of cerebral hemorrhage.