| Objectives To evaluate the effectiveness and safety of tirofiban in preventing vascular reocclusion by early combined application of tirofiban in patients with mild disabling stroke who have been successfully treated with alteplase by intravenous thrombolysis.Methods The researchers selected 70 patients with Mild disabling stroke(MDS)who were admitted to the Department of Neurology of the North China University of Technology Affiliated Hospital from September 2017 to September 2019 as the experimental group,and selected 76 patients with mild disabling stroke who did not receive tirofiban during the same period as the control group.Both groups were given the standard dose of alteplase intravenous thrombolytic therapy.The experimental group immediately reviewed the CT of the brain after successful intravenous thrombolytic therapy(that is,the NIHSS score was reduced by ? 2 points)to exclude cerebral hemorrhage and bleeding in other parts.The subjects received tirofiban(12.5mg is dissolved in 100 ml normal saline,firstly pumped in 0.4ug/kg/min intravenously for 30 min,then changed to 0.1ug/kg/min for 24h)antiplatelet therapy within 1 hour of intravenous thrombolysis.Both the experimental group and the control group rechecked the craniocerebral CT 24 hours after intravenous thrombolysis.If there was no bleeding,they were given aspirin enteric-coated tablets 100 mg antiplatelet therapy for three months.Both groups of patients were given the same doses of routine treatment such as lipidlowering,stable plaque,open collateral circulation,etc.Researchers recorded various evaluation indicators of clinical effectiveness.The main indicators of clinical effectiveness were expressed by the number of cases of vascular reocclusion.The secondary indicators were evaluated by the neurological deficit grade scale after 7 days and 14 days of treatment.The long-term prognosis of the study was expressed using a modified m RS scale score three months later;at the same time,there were detailed records of adverse events such as skin and mucous membrane bleeding,gum bleeding,vomiting and melena,hematuria,and symptomatic intracranial hemorrhage during the hospitalization period.The researchers further evaluated the safety of the treatment plan based on the above indicators.The researchers also divided the patients into five types according to the Chinese ischemic stroke subtype(CISS classification),including perforating branch artery disease(PAD),aortic atherosclerosis(AA),and cardiac stroke(CS),Other causes(OE),Uncertain cause(UE),and they further analyzed the effects of tirofiban on the clinical efficacy and long-term prognosis of patients with MDS under different classifications.Results 1 Comparison of vascular reocclusion in the experimental group and the control group:After 14 days of treatment,4 cases of vascular reocclusion occurred in the experimental group,with an incidence rate of 5.7%;13 cases of vascular reocclusion occurred in the control group,with an incidence of 17.1%.The difference between the two groups was statistically significant(P=0.032,?2 =4.596),and the time of reocclusion was mainly concentrated within 24 hours after thrombolysis.2 Comparison of the clinical efficacy of the experimental group and the control group:the clinical efficacy was evaluated by the rate of change of the integral value of the degree of neurological deficit.After 7 days of treatment,the total effective rate of the experimental group was 58.6% and that of the control group was 42.1%.(P=0.047,?2 =3.952);after 14 days of treatment,the clinical efficacy experimental group was 80.0%,the control group was 63.2%,the difference was statistically significant(P=0.025,?2 =5.044).3 Comparison of the long-term efficacy of the experimental group and the control group:good long-term prognosis was evaluated by m RS score ? 1 point after three months,the good prognosis rate of the experimental group was 84.3%,and the control group was 65.8%,the difference was statistically significant(P<0.05).4 Safety evaluation of the experimental group and the control group:In the experimental group,there were 2 cases of hematuria,3 cases of black stools,and 1 case of bleeding gums.The control group had 1 case of hematuria,2 cases of black stools,and 3 cases of gum bleeding.No symptomatic intracranial hemorrhage and severe liver and kidney damage occurred in the two groups,and the difference in the incidence of adverse events was not statistically significan(P<0.05).5 There was no significant difference in the incidence of adverse events between the two groups of subjects(P>0.05),and no severe bleeding or death occurred in both groups.Conclusions 1 Tirofiban can effectively prevent the occurrence of vascular reocclusion.2 Tirofiban can effectively improve the patient's short-term neurological function and long-term prognosis.3 The use of tirofiban within 1 hour in patients with mild disabling stroke who have undergone intravenous thrombolysis with alteplase is safe.4 Tirofiban can significantly improve the clinical efficacy and prognosis of patients with mild disabling stroke of PAD.Table 10,Reference 93... |
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