颅外颈动脉支架术后抗血小板治疗方案的对比研究

发布时间：2018-03-30 09:05

本文选题：颅外颈动脉　切入点：支架　出处：《重庆医科大学》2017年硕士论文

【摘要】：背景:血管内支架术已成为治疗与预防缺血性脑卒中的重要措施,但颅外颈动脉支架术后对比单用阿司匹林或氯吡格雷长期抗血小板治疗效果的研究较少,且不同Essen评分组间支架术后两种抗血小板药物的效果目前报道甚少。目的:通过1年的随访,对比颅外颈动脉支架术后单用阿司匹林或氯吡格雷不良终点事件的发生率,并比较不同Essen评分组间是否存在差异。方法:收集2014年1月至2015年1月于重庆医科大学附属第一医院及第三军医大学附属新桥医院接受颅外颈动脉支架置入术的新发缺血性脑卒中患者219例,术后予以双联抗血小板(阿司匹林100mg/d及氯吡格雷75mg/d),应用1个月(69例)或3个月(150例),然后单用阿司匹林(124例)100mg/d或氯吡格雷(95例)75mg/d。并对纳入患者进行Essen评分,分为低危组(41例)及高危组(178例)。随访1年时的主要终点(同侧脑梗死、非同侧脑梗死、心肌梗死、死亡)及次要终点(颅内或颅外出血)。结果:阿司匹林组与氯吡格雷组基线特征差异均无统计意义。随访1年时,阿司匹林组主要终点事件同侧脑梗死、非同侧脑梗死、心肌梗死、死亡发生率(分别为2.4%、0.8%、0.8%、0.0%)与氯吡格雷组发生率(分别为1.1%、0.0%、0.0%、0.0%)比较差异无统计学意义(P0.05)。阿司匹林组次要终点事件颅内出血、颅外出血发生率(分别为1.6%、3.2%)与氯吡格雷组发生率(分别为1.1%、1.1%)比较差异亦无统计学意义(P0.05)。Essen评分低危组阿司匹林组主要终点事件同侧脑梗死、非同侧脑梗死、心肌梗死、死亡发生率(分别为4.3%、0.0%、0.0%、0.0%)与氯吡格雷组发生率(分别为0.0%、0.0%、0.0%、0.0%)比较差异无统计学意义(P0.05)。高危组阿司匹林组主要终点事件同侧脑梗死、非同侧脑梗死、心肌梗死、死亡发生率(分别为2.0%、1.0%、1.0%、0.0%)与氯吡格雷组发生率(分别为1.3%、0.0%、0.0%、0.0%)比较差异亦无统计学意义(P0.05)。结论:颅外颈动脉支架术后双联抗血小板治疗1或3个月后,单用阿司匹林或氯吡格雷抗血小板治疗1年内其主要终点事件及次要终点事件发生率无显著差异。不同Essen评分组间两种抗血小板药物的主要终点事件亦无显著差异。需要更大样本的进一步研究。
[Abstract]:Background: endovascular stenting has become an important measure for the treatment and prevention of ischemic stroke, but there are few studies on long-term antiplatelet effects of aspirin or clopidogrel alone after extracranial carotid artery stenting. The efficacy of two antiplatelet drugs in patients with different Essen scores after stenting was rarely reported. Objective: to compare the incidence of adverse endpoint events of aspirin or clopidogrel after extracranial carotid artery stenting. Methods: from January 2014 to January 2015, the patients received extracranial carotid artery stenting in the first affiliated Hospital of Chongqing Medical University and Xinqiao Hospital affiliated to the third military Medical University. 219 new ischemic stroke patients, After operation, patients were treated with dual antiplatelet therapy (aspirin 100mg/d and clopidogrel 75mg / d, 69 cases in 1 month) or 150 cases with 3 months of treatment, and then 124 cases with 100 mg / d aspirin or 95 cases with clopidogrel or 95 cases with clopidogrel respectively. The patients were assessed with Essen. The patients were divided into low risk group (n = 41) and high risk group (n = 178). The main endpoints (ipsilateral cerebral infarction, non-ipsilateral cerebral infarction, myocardial infarction) were followed up for one year. Results: there was no significant difference in baseline characteristics between aspirin group and clopidogrel group. After one year follow-up, the main endpoint events of aspirin group were ipsilateral cerebral infarction and non-ipsilateral cerebral infarction. There was no significant difference in the incidence of myocardial infarction, mortality (2. 4% and 0. 8%) and clopidogrel group (1. 1%, 0. 0% and 0. 0%). There was no significant difference between aspirin group and clopidogrel group (P 0. 05). There was no significant difference between the incidence of extracranial hemorrhage (1.6 / 3.2g) and clopidogrel group (1.1 / 1.1, respectively). There was no significant difference between the aspirin group and the aspirin group (P 0.05). Essen score was lower than that in the aspirin group, and the main end point events were ipsilateral cerebral infarction, non-ipsilateral cerebral infarction, myocardial infarction, and myocardial infarction. There was no significant difference in the incidence of death between the group of clopidogrel and the group of clopidogrel (P 0.05). There was no significant difference in the incidence of death between the aspirin group and the clopidogrel group. There was no significant difference in the incidence of death between the aspirin group and the clopidogrel group (P 0.05). The main endpoint events in the high risk group were ipsilateral cerebral infarction, non-ipsilateral cerebral infarction, myocardial infarction, and myocardial infarction. There was no significant difference in the incidence of death between the group of clopidogrel and the group of clopidogrel (1.3and 0.010, respectively). Conclusion: one or three months after dual antiplatelet therapy for extracranial carotid artery stenting, there was no significant difference in the incidence of death (P 0.05). There was no significant difference in the incidence of major endpoint events and secondary endpoint events within one year after antiplatelet therapy with aspirin or clopidogrel alone. There was no significant difference in the main endpoint events between the two antiplatelet drugs in different Essen score groups. Different. Further research is needed for a larger sample.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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