Study On The Efficacy And Safety Of Alteplase Combined With Tirofiban In The Treatment Of Perforator Arterial Cerebral Infarction

Objective :To investigate the efficacy and safety of Tirofiban in the treatment of acute perforating arterial cerebral infarction patients with neurological deterioration after intravenous thrombolysis of alteplase(rt-PA),in order to find the best drug treatment for patients with progressive perforating artery cerebral infarction.Methods: A total of 539 patients with acute cerebral infarction admitted to the Department of Neurology,Huxi Hospital affiliated to Jining Medical College from January 2020 to December 2021 were selected,and the onset time was within 4.5 hours.The NATIONAL Institutes of Health Stroke Scale was recorded for all patients.Nationa linte of Health Stroke Scale(NIHSS)score,Modified Ranking Scal(mRS)score,exclusion of thrombolytic contraindications,rt-PA intravenous thrombolytic therapy,Complete cranial Magnetic resonance imaging+Magnetic resonance angiography(MRI+MRA)after thrombolysis.According to the Classification criteria of China Ischemic Stroke Substype CISS(China Ischemic Stroke Substype CISS),172 patients with perforator arterial cerebral infarction were screened out.Sixty of the patients showed early neurological deterioration(END)within 24 hours after thrombolytic therapy.The 60 patients were randomly divided into observation group and control group.The observation group(n=30)was given tirofiban for 24 hours,while the control group(n=30)continued to receive routine treatments such as lowering lipid,improving circulation and nourishing brain cells.Baseline data of all subjects were collected,and NIHSS score,mRS score and incidence of adverse events(post-stroke depression,reinfarction,bleeding,death and other indicators)were compared between the two groups at different time points before and after treatment.Results: 1.Comparison of baseline data between the two groups: age,gender,history of hypertension,history of diabetes,history of smoking,low density lipoprotein,total cholesterol,etc.,were not significantly different(P>0.05),and the two groups were comparable.2.NIHSS score comparison: NIHSS scores of the observation group and the control group before thrombolytic therapy were 4.07±3.10 and 4.33±3.39,P>0.05,with no statistical significance;NIHSS scores of the observation group and the control group were 7.80±3.22 and 7.83±3.36,P > 0.05,the difference was not statistically significant.NIHSS scores of the observation group and the control group were 3.73±3.60 and5.43±3.81 respectively 24 hours after thrombolytic therapy,P > 0.05,with no statistical significance.NIHSS scores of the observation group and the control group were2.73±2.64 and 4.33±2.76 at 7 days after thrombolytic,P <0.05,the difference was statistically significant.NIHSS scores of the observation group and the control group were 2.13±2.26 and 3.53±2.24 at 14 days after thrombolytic therapy,P < 0.05,the difference was statistically significant.3.mRS score comparison: mRS scores of the observation group and the control group before thrombolytic therapy were 1.93±1.17 and2.13±1.22(P>0.05),with no statistically significant difference;mRS scores of the observation group and the control group were 3.37±1.30 and 3.87±1.25,P > 0.05,and the difference was not statistically significant.mRS scores were 2.17±1.37 and 2.90±1.52 in the observation group and the control group 24 hours after thrombolytic therapy,P > 0.05,the difference was not statistically significant.mRS scores of the observation group and the control group at 14 days after thrombolytic therapy were 1.63±1.03 and 2.40±1.25,P<0.05,the difference was statistically significant.mRS scores of the observation group and the control group 90 days after thrombolytic therapy were 0.87±1.01 and 1.63±0.93,P<0.05,the difference was statistically significant.4.Incidence of adverse events:90 days after treatment,post-stroke depression occurred in 3.3% of the observation group and26.6% of the control group,P<0.05,the difference was statistically significant;There was6.6% reinfarction in the observation group and 36.6% reinfarction in the control group,and the difference was statistically significant(P<0.05).Cerebral hemorrhage occurred in the observation group(10%)and the control group(3.0%),with no statistically significant difference(P >0.05).There were no death cases or bleeding in other parts in 2 groups,and P > 0.05 was not statistically significant.Conclusions: Patients with acute perforating arterial cerebral infarction have neurological deterioration within 24 hours after intravenous thrombolysis with rt-PA,Tirofiban treatment can improve the prognosis without increasing the risk of bleeding and death,and is clinically effective and relatively safe.