| Research objective To explore the efficacy,safety and long-term prognosis of intravenous infusion of tirofiban for 48 hours and 72 hours in the treatment of moderate progressive cerebral infarction,and to analyze the risks and benefits of the two treatment schemes,so as to provide theoretical basis for corresponding clinical treatment.Method A prospective,randomized,parallel controlled clinical trial design method was adopted in this study.Ninety-eight subjects who met the exclusion criteria of this study were randomly divided into experimental group(n = 49)and control group(n = 49).30 min was infused intravenously with tirofiban 0.4ug/(kg.min)in both groups,followed by continuous intravenous infusion with 0.1ug/(kg.min).Tirofiban was injected intravenously for 72 hours in the test group and 48 hours in the control group.After tirofiban treatment,two groups of patients were given oral antiplatelet aggregation drugs,statins to regulate blood lipids and stabilize plaques and other routine treatment.Except for the continuous medication time of rofiban,the other conditions of the two groups were the same.The National Institutes of Health Stroke scale(NIHSS)was used to evaluate the severity of the disease and the short-term efficacy of the two methods before treatment and on the 1st,2nd,3rd and 7th day after treatment,in which 0 was normal,1-4 was mild,5-15 was moderate,16-20 was moderate and 21-42 was severe.The modified Rankin revised scale(MRS)was used to evaluate the long-term prognosis before treatment,1 day after treatment and 3 months after treatment.NIHSS and MRS were reviewed by at least two attending physicians and above.The blood routine of the patients was tested before treatment and at 1 hour,6hours,2 days,3 days,7 days to observe whether there was thrombocytopenia or nose.the safety of medication was evaluated by paying attention to the possible bleeding signs such as black stool,skin and mucous membrane ecchymosis,mouth and nose abnormal bleeding,vaginal bleeding,headache and abdominal pain.Results1.There was significant interaction between the test group and the control group in improving the condition and short-term effect of tirofiban in patients with moderate progressive cerebral infarction(P=0.006).Then the individual effects of different treatment schemes on NIHSS score were analyzed.There was significant difference in NIHSS score between the two groups on the 7th day(P < 0.001).There was no significant difference between the two groups before treatment,1-day,2-day and3-day(P > 0.05).The separate effects of different observation times in the two groups were analyzed,and the differences between the experimental group before and after 3days of medication were statistically significant(P=0.003),between before and after 7days of medication were statistically significant(P < 0.001),and between 1 and 3 days of medication were statistically significant(P=0.001).The difference between 1 day and7 days of medication was statistically significant(P < 0.001),the difference between 2days and 7 days of medication was statistically significant(P < 0.001),the difference between 3 days and 7 days of medication was statistically significant(P < 0.001).In the control group,the difference between 1 day and 7 days of medication was statistically significant(P < 0.001),the difference between 2 days and 3 days of medication was statistically significant(P=0.003),the difference between 2 days and 7 days of medication was statistically significant(P < 0.001),and the pairwise comparison at other time points showed no statistically significant differences(P > 0.005).2.The analysis of the influence of Tirofiban on the MRS Score of patients with moderate progressive cerebral infarction showed no statistical significance in the interaction between the two groups(P=0.803).The main effect of the group and the observation point was analyzed and the MRS Score between the two groups was compared,showing no statistical significance(P=0.076).The difference of MRS Score was statistically significant at the observation time points(P < 0.001),and the difference of MRS Score at different time points was statistically significant at 3months compared with before medication and 1 day after medication(P < 0.001),but there was no statistically significant difference between before medication and 1 day after medication(P=0.259).3.Effect of tirofiban on platelet related indexes in the treatment of moderate progressive cerebral infarction.The main results were as follows:(1)Platelet count: the interaction between the two groups was not statistically significant(P > 0.005).There was no significant difference in platelet count between the two groups(P > 0.05).There was no significant difference in platelet count between the two groups(P > 0.05).(2)mean platelet volume: there was no significant interaction between the two groups(P = 0.670).The main effects of groups and observation time points were analyzed,and there was no significant difference in average platelet volume between the two groups(P = 0.511).The difference of average platelet volume between the two groups was statistically significant(P < 0.001),and the average platelet volumes at different time points were compared in pairs.There was significant difference between6 hours and 3 days(P < 0.005),but there was no significant difference in other time points(P > 0.05).(3)Thrombocrit: the interaction between the two groups was not statistically significant(P = 0.238).The main effects of groups and observation time points were analyzed,and there was no significant difference in thrombocrit between the two groups(P = 0.130).There was significant difference in thrombocrit changes between the two groups at observation time points(P = 0.003),and a pairwise comparison was made between different time points.It was found that there was significant difference between 6 hours and 3 days(P < 0.05),but there was no significant difference among other time points(P > 0.005).2.In terms of improving the condition and short-term effect of tirofiban in patients with moderate progressive cerebral infarction,the NIHSS score decreased in both groups after treatment,which was significantly different from that before treatment(P < 0.05),the 72-hour group was better than the 48-hour group.4.In the treatment of moderately progressive cerebral infarction with Tirofiban,adverse bleeding events did not increase in the 72-hour group compared with the48-hour group due to prolonged medication time,and no major bleeding events occurred in the two groups,with no statistical significance between the two groups(P >0.05).Conclusion1.NIHSS score of curative effect index:Tirofiban for 48 hours and 72 hours in patients with moderate progressive cerebral infarction could decrease the NIHSS score within 1 week and improve the symptoms of short-term neurological deficit.Prolonging the treatment time to 72 hours could improve the symptoms earlier on the third day than those who stopped taking tirofiban for 48 hours,and it could greatly reduce the NIHSS score and improve the symptoms of the patients on the 7th day.2.MRS score of curative effect index : Tirofiban can reduce MRS Scores of patients with moderate progressive cerebral infarction after 3 months and improve the long-term prognosis of patients.However,patients who took the drug longer to 72 hours did not gain more long-term benefits than those who stopped taking the drug at 48 hours.3.Safety index platelet related test:The platelet related indexes(platelet count,mean platelet volume and hematocrit)fluctuated to some extent in the early stage of tirofiban in the treatment of moderate progressive cerebral infarction(within 1 day).The range of fluctuation was the largest at 6 hours,although no patients with platelet related indexes were found to be beyond the normal range in this study.However,it is still suggested that doctors should closely observe the early condition of patients treated with tirofiban and review platelet related indexes in time.4.Safety indicator bleeding event:Prolonged tirofiban administration did not significantly increase the occurrence of bleeding events.In this study,there were no serious adverse bleeding reactions such as intracranial hemorrhage or symptomatic cerebral hemorrhage.Among them,there were 4 possible drug bleeding events: small gingival bleeding in 2 cases and small perineal bleeding in 2 cases.According to Bleeding Academic Research Consortium(BARC)to 1-2 type micro bleeding. |
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