輕型缺血性卒中靜脈溶栓后雙重抗血小板治療研究

張曉鑫+王艷+楊清成

【摘要】目的觀察輕型缺血性卒中患者重組組織型纖溶酶原激活劑（rt-PA）靜脈溶栓后使用雙重抗血小板治療的臨床療效。方法選取2013年7月～2016年10月在神經(jīng)內(nèi)科治療的80例輕型缺血性卒中患者，按治療方法分為傳統(tǒng)組（n=40）和觀察組（n=40）。傳統(tǒng)組靜脈溶栓后給予阿司匹林長(zhǎng)期治療；觀察組靜脈溶栓后給予阿司匹林聯(lián)合氯吡格雷治療3周，然后繼續(xù)單用阿司匹林長(zhǎng)期治療。3個(gè)月后評(píng)估兩組患者的NIHSS評(píng)分、BI評(píng)分、mRS評(píng)分，評(píng)估3個(gè)月內(nèi)患者的腦出血率、病死率和腦梗死復(fù)發(fā)率。結(jié)果兩組患者入院時(shí)NIHSS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；治療3個(gè)月后，傳統(tǒng)組患者預(yù)后情況較觀察組差（P<0.05）；觀察組腦梗死復(fù)發(fā)率低于傳統(tǒng)組，但比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論輕型缺血性卒中靜脈溶栓后，短期給予雙重抗血小板治療能夠提高療效，腦梗死復(fù)發(fā)率略有降低，且不增加出血的風(fēng)險(xiǎn)。

【關(guān)鍵詞】輕型；缺血性卒中；雙重抗血小板

中圖分類號(hào)：R743.3文獻(xiàn)標(biāo)識(shí)碼：ADOI：10.3969/j.issn.1003-1383.2017.06.014

【Abstract】ObjectiveTo observe the clinical efficacy of dual antiplatelet therapy after the recombinant tissue plasminogen activator （rt-PA） intravenous thrombolysis in patients with light ischemic stroke.Methods80 cases of light ischemic stroke patients treated in department of neurology from July，2013 to October，2016 were selected.All patients were divided into traditional group（n=40）and observation group（n=40）according to treatment method.The traditional group were given long-term aspirin treatment after intravenous thrombolysis；the observation group were treated with aspirin combined with clopidogrel for 3 weeks after intravenous thrombolysis，and then aspirin alone was continued to be use for long-term treatment.After 3 months，NIHSS score，BI score and mRS score of the two groups were evaluated，and the cerebral hemorrhage rate，mortality rate and recurrence rate of cerebral infarction were evaluated within 3 months.ResultsThere was no statistically significant difference in NIHSS scores between the two groups at admission（P>0.05）.After 3 months of treatment，the prognosis of the traditional group was worse than that of the observation group（P<0.05）.The recurrence rate of cerebral infarction in the observation group was lower than that in the traditional group，but difference was not statistically significant（P>0.05）.ConclusionAfter the thrombolytic thrombolysis of light ischemic stroke，short-term double antiplatelet therapy can improve the efficacy，reduce the incidence of cerebral infarction，and do not increase the risk of bleeding

【Key words】light；ischemic stroke；double antiplatelet

輕型卒中是一種血管原因所致的突發(fā)性局灶性輕型神經(jīng)功能障礙（NIHSS≤3分），持續(xù)時(shí)間≥24 h[1]。在急性腦血管病事件中，輕型卒中包括短暫性腦缺血發(fā)作（TIA）和急性缺血性卒中；其臨床表現(xiàn)為一過性肢體麻木、無(wú)力、失語(yǔ)、失神等神經(jīng)功能障礙，可以完全緩解或者癥狀輕微，常不引起人們的重視，或者重視不充分，之后往往導(dǎo)致災(zāi)難性后果。因此，該研究旨在分析輕型急性缺血性腦卒中患者靜脈溶栓后，采用雙重抗血小板治療的安全性及療效，現(xiàn)報(bào)道如下。1資料與方法1.1臨床資料選取2013年7月～2016年10月在我院神經(jīng)內(nèi)科治療的80例輕型缺血性卒中患者，所有患者的臨床癥狀和檢查結(jié)果均符合指南標(biāo)準(zhǔn)和溶栓標(biāo)準(zhǔn)。溶栓標(biāo)準(zhǔn)：①年齡18～70歲；②引起可評(píng)估的神經(jīng)缺損；③卒中持續(xù)1 h無(wú)改善；④發(fā)病時(shí)間在4～5 h內(nèi)；⑤NIHSS評(píng)分≥4分；⑥排除腦內(nèi)出血，無(wú)早期大面積腦梗死改變。傳統(tǒng)組40例，男24例，女16例；年齡50～77歲，平均（64.5±7.9）歲；發(fā)病時(shí)間60～242 min，平均（130.8±22.4）min；合并高血壓12例，糖尿病3例。觀察組40例，男26例，女14例；年齡52～76歲，平均（63.8±7.5）歲；發(fā)病時(shí)間55～246 min，平均（131.4±22.9）min；合并高血壓10例，糖尿病4例。兩組患者的性別、年齡、發(fā)病時(shí)間、合并癥等比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），有可比性。endprint