Application of tirofiban in the perioperative period of patients with emergency neurovascular surgery
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摘要: 目的 探讨替罗非班在急诊神经血管介入术患者围术期中的应用效果。 方法 选取2016年1月—2018年6月西安交通大学第二附属医院神经内科收治的急诊行支架置入的急性缺血性卒中(AIS)患者94例,根据术前抗血小板治疗方案将患者分为常规治疗组与替罗非班组。常规治疗组患者术前进行充分的双联抗血小板治疗; 替罗非班组患者术前双联抗血小板治疗不足3 d, 术中给予阿司匹林肠溶片和硫酸氢氯吡格雷片负荷剂量,同时给予盐酸替罗非班。比较2组患者治疗前和治疗后3 d的美国国立卫生研究院卒中量表(NIHSS)评分、血小板计数及出血事件(颅内出血、全身性出血)发生情况, 3个月后评估改良Rankin量表(mRS)评分。 结果 治疗后3 d, 2组NHISS评分均显著降低,且替罗非班组下降更为显著(P<0.05)。与术前相比, 2组术后3 d的血小板计数均显著增高(P<0.05), 但2组术后3 d的血小板计数比较无显著差异(P>0.05)。2组患者均未发生颅内出血, 2组患者出血事件发生情况比较无显著差异(P>0.05)。2组患者术后3个月的临床神经功能均显著改善,且替罗非班组改善效果显著优于常规治疗组(P<0.05)。 结论 在急诊神经血管介入围术期应用替罗非班疗效显著,可降低患者远期复发率和病死率,改善患者神经功能缺损状况,用药安全性较高。Abstract: Objective To investigate the effect of tirofiban in the perioperative period of patients with emergency neurovascular intervention. Methods From January 2016 to June 2018, a total of 94 acute ischemic stroke(AIS)patients with stent placement in the Department of Neurology of Second Affiliated Hospital of Xi'an Jiaotong University were selected, and they were divided into routine treatment group and tirofiban group according to the preoperative anti-platelet therapy. Patients in the routine treatment group were given adequate dual anti-platelet therapy before operation, while patients in the tirofiban group were treated with dual anti-platelet therapy less than 3 days before operation, loading doses of aspirin enteric coated tablets and clopidogrel bisulfate tablets during the operation and tirofiban hydrochloride at the same time. The scores of National Institutes of Health Stroke Scale(NIHSS)and blood platelet count before operation and 3 days after operation, bleeding events(such as intracranial hemorrhage, systemic hemorrhage)and the score of modified Rankin Scale(mRS)after 3 months were compared between two groups. Results Three days after treatment, the NIHSS score in both groups significantly reduced, and the NIHSS score in the tirofiban group was significantly lower than that in the routine treatment group(P<0.05). Compared with that before operation, the blood platelet count in both groups was significantly higher at 3 days after operation - (P<0.05), but there was no significant difference between the two groups after operation(P>0.05). There was no intracranial hemorrhage in both groups, and there was no significant difference in bleeding events between the two groups(P>0.05). The clinical neurological function of the two groups improved significantly at 3 months after operation, and the improvement effect of the tirofiban group was significantly better than that of the routine treatment group(P<0.05). Conclusion Application of tirofiban shows a significant therapeutic effect in the perioperative period of patients with emergency neurovascular intervention, which can reduce the long-term recurrence rate and mortality, improve the status of neurological deficit, and it has higher safety.
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