急性期联合抗血小板治疗对进展性缺血性卒中的安全性和效能评价

发布时间：2019-05-30 05:32

【摘要】：目的：在急性期联合抗血小板治疗对进展性缺血性卒中的安全性和效能评价。方法：对沈阳军区总医院2009年1月-2012年6月期间收治的301例缺血性脑血管病患者的临床资料进行回顾性分析。301例均为发病在72小时以内，并经头CT或MRI被证实为缺血性脑血管病。所有患者均收入神经内科病房，并在入院时、症状加重时、入院后第14天进行NIHSS评分。281例急性脑梗死患者采用2007年Han等提出的改良TOAST病因学分型。其中，20例为短暂性脑缺血发作，患者根据ABCD2评分标准进行高、中、低分层。患者随机分为负荷剂量组（首剂氯吡格雷300mg,次日改为阿司匹林和氯吡格雷联合）和单一用药组（单用阿司匹林）。2011年10月后加入另外一组：联合用药组（阿司匹林和氯吡格雷联合）。其中负荷剂量组男116例，女14例，年龄36-86岁，平均为60.71±11.58；联合用药组男27例，女10例，年龄33-80岁，平均为61.72±11.55；单一用药组男116例，女18例，年龄27-87岁，平均为61.01±12.25。负荷剂量组入院当日给予口服氯吡格雷300mg负荷剂量，次日改为氯吡格雷75mg+阿司匹林100mg口服每天一次，联用2周；单一用药组于入院当日服用拜阿司匹林300mg口服每天一次，联用2周；联合用药组于入院当日服用氯吡格雷75mg+阿司匹林100mg口服每天一次，联用2周。2周后三组均改为常规预防剂量拜阿司匹林100mg口服每天一次。结果：134例单药组治疗患者入院NIHSS评分为3.25±2.40，治疗2周后NIHSS为1.96±2.16，治疗前后比较有统计学意义（P＜0.001）；130例负荷剂量组治疗患者入院NIHSS评分为3.95±2.81，治疗2周后NIHSS为2.22±2.36，治疗前后比较有统计学意义（P＜0.001）；37例联合用药组治疗患者入院NIHSS评分为3.65±2.25，治疗2周后NIHSS为2.11±2.29，，治疗前后比较有统计学意义（P＜0.001）。20例TIA患者中，阿司匹林组1例发生卒中；281例脑梗死患者进展36例，其中134例单药组脑梗死患者发生进展26例，130例负荷剂量组脑梗死患者发生进展8例，37例联合用药组脑梗死患者发生进展2例。其中单药组82例大动脉粥样硬化型脑梗死患者发生进展23例（28.05%），负荷剂量组79例大动脉粥样硬化型脑梗死发生进展7例（8.86%），联合用药组31例大动脉粥样硬化型脑梗死患者发生进展2例（6.45%）。安全性方面：三组在治疗期间，发生非致死性出血共7例，其中，负荷剂量组牙龈出血2例，泌尿系出血1例，皮肤粘膜出血1例；联合用药组牙龈出血1例；阿司匹林组中牙龈出血1例，皮肤粘膜出现1例。三组中均未发生致命性消化道大出血及颅内出血，均未发生血细胞减少、凝血功能障碍、哮喘等其他不良反应。结论：1.对于缺血性卒中或TIA患者给予急性期抗血小板治疗，治疗后其神经功能缺损评分明显改善；2.在本研究，卒中和TIA后72小时以内给予300mg负荷剂量的氯吡格雷和300mg阿司匹林是安全有效的；3.对于预防进展性缺血性脑梗死，氯吡格雷负荷量后阿司匹林联合氯吡格雷的联合治疗是一种安全有效的急性期抗血小板治疗方案，与单一抗血小板治疗相比，可显著降低卒中复发和进展性缺血性卒中的发生率，尤其是大动脉粥样硬化型脑梗死进展的发生率。
[Abstract]:Objective: To evaluate the safety and efficacy of combined antiplatelet therapy in acute stage of ischemic stroke. Methods: The clinical data of 301 patients with ischemic cerebrovascular disease admitted to the General Hospital of Shenyang Military Region from January 2009 to June 2012 were analyzed retrospectively. Disease. All patients were admitted to the Neurological Ward and, at the time of admission, the NIHSS score was performed on the 14th day after admission.281 patients with acute cerebral infarction introduced the modified TOAST cause credits, such as Han et al.,2007 Type. Of these,20 are transient ischemic attack, and the patient is subject to high, medium and low score according to the ABCD2 standard. The patient was randomly divided into a load dose group (first dose of chloro-gregrel 300 mg, the following day was changed to aspirin and chlorofluorocarbon) and a single-use group (aspirin alone). Another group was added after October 2011: a combination group of drugs (aspirin and chlorofluorocarbon) The average age was 60.71 and 11.58, and the average was 61.72 and 11.55, and the average was 61.72 and 11.55, and the average was 61.01 to 12.2. 5. On the day of admission, the loading dose group was given a dose of 300 mg of oral chloride, and the following day was changed to a dose of 75 mg + aspirin and 100 mg of aspirin per day for 2 weeks; the single-use group was taken with aspirin 300 mg once a day on the day of admission and used in combination with 2 The combined treatment group was orally taken orally once a day for 2 weeks on the day of admission. The three groups were changed to routine preventive dose of 100 mg per day for oral administration. Results: The NIHSS score was 3.25-2.40 in 134 patients with single-group treatment, and the NIHSS was 1.96-2.16 after 2 weeks of treatment. The NIHSS score was 3.95-2.81 after 2 weeks of treatment. The NIHSS was 2.22-2.81 after 2 weeks of treatment. .36. There was a significant difference before and after treatment (P <0.001); in 37 cases, the NIHSS score was 3.65-2.25 in 37 cases, and the NIHSS was 2.11-2.29 after 2 weeks of treatment, and there was a significant difference before and after treatment (P <0.001). In 20 patients with TIA,1 case of aspirin group was found. In the stroke, there were 36 cases of cerebral infarction, including 26 cases of cerebral infarction in 134 cases,8 cases of cerebral infarction in 130 cases of loading dose group, and 37 cases of cerebral infarction in combination group. There were 23 cases (28.05%) of the patients with high-artery atherosclerosis in the single-group and 7 (8.8%) in the load-dose group in 79 cases of atherosclerosis type cerebral infarction (8.8%). 2 cases (6.4%) in 31 patients with atherosclerosis type cerebral infarction (6.4%) 5%). Safety: There were 7 cases of non-fatal bleeding during the treatment period, including 2 cases of gingival bleeding,1 case of urinary tract hemorrhage,1 case of skin and mucous membrane,1 case of gingival bleeding in combination group, and gingival bleeding in the aspirin group. 1 case of blood, mucous membrane of skin There were no major bleeding in the digestive tract and intracranial hemorrhage in the three groups, no blood cell reduction, coagulation disorder, and asthma were observed in the three groups. Good response. Conclusion:1. In patients with ischemic stroke or TIA, acute antiplatelet therapy was given to the patients with ischemic stroke or TIA. a significant improvement;2. In this study, the 300 mg of the load dose of chlorhexidine and 300 mg of aspirin were administered within 72 hours of stroke and TIA 3. In the treatment of progressive ischemic cerebral infarction, the combined treatment of the combination of aspirin with chlorongrel after the loading of the chlorofluorocarbon-gray is a safe and effective anti-platelet therapy in the acute phase, which is less than the single anti-platelet therapy. Compared with plate treatment, the incidence of recurrent and progressive ischemic stroke in stroke can be significantly reduced, especially in the patients with atherosclerosis type cerebral infarction.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.3

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