摘要目的:探讨替罗非班治疗超时间窗急性脑梗死的安全性及有效性。方法:在天津市泰达医院神经内科自2016年1月至2018年5月收治的84例超时间窗(发病时间为4.5~8.0 h)急性脑梗死患者中，对其中42例患者经本人或家属知情同意后于急诊全脑血管造影检查结束后即刻予替罗非班治疗(经微导管动脉泵入负荷量替罗非班，并静脉持续泵入维持量48 h)及强化降脂治疗(研究组)，对剩余42例患者于造影检查结束后即刻予强化抗血小板聚集治疗及强化降脂治疗(对照组)，比较2组患者的疗效、安全性及随访康复情况；同时依据急性梗死部位将研究组患者分为前循环梗死组( n=24)与后循环梗死组( n=18)，比较2组患者的疗效、安全性及随访康复情况。 结果:研究组患者治疗后48 h、7 d、10 d的美国国立卫生研究院卒中量表(NIHSS)评分均明显低于对照组，治疗前后NIHSS评分差值明显高于对照组，3个月后的预后良好[改良Rankin量表(mRS)评分≤2分]比例(78.57%)明显高于对照组(52.38%)，3个月后的Barthel指数评分(94.76±11.67)明显高于对照组(85.00±15.17)，差异均有统计学意义( P<0.05)。后循环梗死组患者治疗后48 h、7 d、10 d的NIHSS评分均明显低于前循环梗死组，治疗前后NIHSS评分差值明显高于前循环梗死组，3个月后的预后良好比例(94.44%)明显高于前循环梗死组(66.67%)，差异均有统计学意义( P<0.05)。研究组与对照组、后循环梗死组与前循环梗死组患者间在血小板计数及凝血四项方面差异均无统计学意义( P> 0.05)。 结论:对于超时间窗急性脑梗死患者，给予替罗非班治疗具有较高的有效性及安全性，且其疗效在后循环梗死患者中更显著。

abstractsObjective:To investigate the safety and efficacy of tirofiban therapy in acute cerebral infarction patients having broadened therapeutic time window.Methods:Eighty-four acute cerebral infarction patients having broadened therapeutic time window (the onset time was within 4.5-8 h), admitted to our hospital from January 2016 to May 2018, were chosen in our study. Forty-two patients (treatment group), with the informed consent of himself or his family, received emergent cerebral angiography and treated with tirofiban (the load of tirofiban was pumped via the microductal artery, and the maintenance load was continuously pumped intravenously for 48 h) right after the angiography; the other 42 patients (control group) received emergent cerebral angiography and treated with intensive antiplatelet aggregation therapy right after the angiography; intensive lipid-lowering therapy was given in both groups. The efficacy, safety and follow-up rehabilitation were compared between the two groups. According to the locations of acute cerebral infarction, patients in the treatment group were divided into anterior circulation infarction subgroup ( n=24) and posterior circulation infarction subgroup ( n=18); the efficacy and follow-up rehabilitation were compared between the two subgroups. Results:Patients from the treatment group had significantly lower National Institutes of Health Stroke Scale (NIHSS) scores 48 h, 7 d, and 10 d after treatment, and significantly higher NIHSS score difference values before and after treatment than those from control group ( P<0.05); the proportion of patents having good prognosis (modified Rankin scale [mRS] scores≤2) in the treatment group 3 months after treatment (78.57%) was significantly higher than that in the control group (52.38%), and the Barthel index in the treatment group 3 months after treatment (94.76±11.67) was significantly higher than that in the control group (85.00±15.17, P<0.05). Patients from the posterior circulation infarction subgroup had significantly lower NIHSS scores 48 h, 7 d, and 10 d after treatment, and significantly higher NIHSS score difference values before and after treatment than those from anterior circulation infarction subgroup ( P<0.05); the proportion of patents having good prognosis in the posterior circulation infarction subgroup 3 months after treatment (94.44%) was significantly higher than that in the anterior circulation infarction subgroup (66.67%, P< 0.05). There were no statistically significant differences in platelet count and coagulation tests between the treatment group and control group, and between the posterior circulation infarction subgroup and anterior circulation infarction subgroup ( P>0.05). Conclusion:Tirofiban could improve the prognoses of patients with acute cerebral infarction in broadened therapeutic time window, enjoying high effectiveness and safety, which are more obvious in the posterior circulation infarction.