双抗血小板对进展性脑卒中患者的脑血流动力学及血小板参数影响的研究

发布时间：2018-03-21 14:47

本文选题：抗血小板聚集　切入点：进展性脑卒中　出处：《医学研究生学报》2017年10期 　论文类型：期刊论文

【摘要】：目的阿司匹林联合氯吡格雷双抗血小板治疗的方案在进展性脑卒中的治疗中已得到推广,但相关指南对进展性脑卒中抗血小板的方案仍无明确定论。文中观察阿司匹林联合氯吡格雷双抗血小板对进展性脑卒中患者脑血流动力学以及血小板参数的影响。方法回顾性分析2014年1月至2016年1月期间于南京市脑科医院住院的82例进展性脑卒中患者(发病时间24 h)临床资料,并按照治疗情况分为单抗组(n=40)和双抗组(n=42)。单抗组口服阿司匹林0.1 g/次,1次/d;双抗组在口服阿司匹林的基础上,另给予口服氯吡格雷75 mg/次,1次/d,治疗21 d后改为单独服用阿司匹林。入院第1、7天和3个月后分别评估患者的美国国立卫生研究院卒中量表(NIHSS)得分以及生活自理能力巴氏指数(BI)。行经颅多普勒检查评估脑血流动力学情况,使用血栓弹力图仪检测血小板抑制率,并检测血小板计数(PLT)、血小板压积(PCT)、平均血小板体积(MPV)、血小板体积分布宽度(PDW)等血小板参数。结果治疗7 d和3个月后,双抗组患者的NIHSS较单抗组显著降低、BI得分较单抗组显著上升(P0.05)。双抗组在治疗7 d后经二磷酸腺苷(ADP)途径诱导的血小板抑制率较单抗组显著上升(P=0.003)。治疗7 d后,双抗组的PLT水平较单抗组明显升高(P=0.006),MPV、PDW则较单抗组明显下降(P=0.023、P=0.017);3个月后,双抗组的PDW仍显著低于单抗组(P=0.041)。治疗7 d后,双抗组双侧大脑中动脉收缩期峰值血流速度Vs、平均血流速度Vm较单抗组下降(P0.05)。3个月后,双抗组的Vs、脉动指数PI较单抗组进一步改善(P0.05)。结论阿司匹林联合氯吡格雷双抗血小板可改善进展性脑卒中患者的脑血流动力学和血小板参数,从而改善临床疗效,效果优于阿司匹林单抗。
[Abstract]:Objective Aspirin combined with clopidogrel double antiplatelet therapy has been popularized in the treatment of progressive stroke. The effects of aspirin combined with clopidogrel on cerebral hemodynamics and platelet parameters in patients with progressive stroke were observed. Methods the clinical data of 82 patients with progressive stroke (24 h) who were hospitalized in Nanjing brain Hospital from January 2014 to January 2016 were retrospectively analyzed. They were divided into two groups according to the treatment conditions: the McAb group (n = 40) and the double antibody group (n = 42). The monoclonal antibody group was given aspirin 0.1 g / once a day, and the double antibody group was based on the oral administration of aspirin. In addition, oral clopidogrel 75 mg/ / 1 / d was administered to aspirin alone after 21 days of treatment. The NIH scores and life self-care were evaluated 7 and 3 months after admission, respectively. Capacity pasteurization index (CBI). Evaluation of cerebral hemodynamics by transcranial Doppler examination, Thromboelastography was used to detect platelet inhibition rate, platelet count, platelet count, platelet aggregation, mean platelet volume MPV, platelet volume distribution width (PDW), and so on. Results after 7 days and 3 months of treatment, the platelet count was measured. The NIHSS scores in the double antibody group were significantly lower than those in the monoclonal antibody group. The platelet inhibition rate induced by the adenosine diphosphate pathway in the double antibody group was significantly higher than that in the monoclonal antibody group after 7 days of treatment. After 7 days of treatment, the platelet inhibition rate in the double antibody group was significantly higher than that in the monoclonal antibody group. After 7 days of treatment, the platelet inhibition rate in the double antibody group was significantly higher than that in the monoclonal antibody group. The level of PLT in the double antibody group was significantly higher than that in the monoclonal antibody group. The level of PDW in the double antibody group was significantly lower than that in the monoclonal antibody group, and the PDW in the double antibody group was still significantly lower than that in the monoclonal antibody group after 7 days of treatment, and after 7 days of treatment, the level of PDW in the double antibody group was still significantly lower than that in the monoclonal antibody group. The peak systolic blood flow velocity of bilateral middle cerebral artery in double antibody group was lower than that of monoclonal antibody group (P < 0.05), and the mean velocity of blood flow was lower than that of monoclonal antibody group (P < 0.05) 3 months later. Conclusion Aspirin combined with clopidogrel can improve cerebral hemodynamics and platelet parameters in patients with progressive stroke. The effect was better than that of aspirin monoclonal antibody.
【作者单位】：南京医科大学附属脑科医院脑血管病救治中心;南京医科大学附属儿童医院新生儿医疗中心;
【分类号】：R743.3

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