本文選題：缺血性腦卒中　切入點(diǎn)：氯吡格雷　出處：《河北醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:缺血性腦卒中是各類原因?qū)е履X部血液供給障礙而出現(xiàn)的腦組織缺血壞死。是神經(jīng)內(nèi)科最常見的多病因疾病,其預(yù)后差,致死和致殘率高,給患者家庭和社會帶來沉重的負(fù)擔(dān),是現(xiàn)階段我國衛(wèi)生康健事業(yè)所面臨的最大挑戰(zhàn)之一。體內(nèi)血小板的活化、粘附和聚集與此種疾病的進(jìn)展密切相關(guān)�？寡“逯委熓侨毖阅X卒中二級預(yù)防中的基本治療。氯吡格雷是一種吩噻吡啶類抗血小板藥物,臨床應(yīng)用安全性高,能顯著降低缺血性事件的相對危險性。“血小板功能反跳”是近年來在缺血性心腦血管病患者中斷氯吡格雷治療后發(fā)現(xiàn)的。目前尚缺乏一個確切、科學(xué)的界定,且沒有前瞻性的試驗(yàn)報(bào)道抗血小板藥物停用后血小板活性反跳與不良局部缺血事件之間存在直接關(guān)聯(lián)。本研究通過PL-11血小板功能監(jiān)測儀監(jiān)測血小板功能,分析氯吡格雷與血小板功能反跳的關(guān)系,以及血小板功能反跳與再發(fā)缺血性腦卒中的相關(guān)性,指導(dǎo)臨床合理用藥。方法:搜集在哈勵遜國際和平醫(yī)院神經(jīng)內(nèi)科2014年9月至2015年11月就診于神經(jīng)內(nèi)科服用氯吡格雷的缺血性卒中患者289例。同時開始監(jiān)測這些患者的血小板功能(ADP二磷酸腺苷、AA花生四烯酸)并隨訪統(tǒng)計(jì)出堅(jiān)持服藥和因各種原因停服氯吡格雷的患者,繼續(xù)進(jìn)行血小板功能檢測至少2個月,觀察血小板聚集“反跳”情況或主要終點(diǎn)事件(缺血性)的發(fā)生情況的相關(guān)性。采用SPSS19.0統(tǒng)計(jì)軟件對數(shù)據(jù)進(jìn)行χ2分析,檢驗(yàn)標(biāo)準(zhǔn)α=0.05,以P0.05表明差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、289例患者中,氯吡格雷抵抗者30例(10.4%),這些患者繼續(xù)隨訪過程中,發(fā)現(xiàn)復(fù)發(fā)短暫性腦缺血發(fā)作TIA或缺血性腦卒中的約8例(26.7%),非氯吡格雷“抵抗”或低反應(yīng)者259例(89.6%)。因各種原因(經(jīng)濟(jì)、出血、健康宣教不到位等)停服氯吡格雷的約153例,停藥比率約為52.9%,停藥后復(fù)發(fā)率是26.8%(Table 1)。2、對停服氯吡格雷的患者繼續(xù)進(jìn)行為期2個月以上(1周、2周、4周時)的血小板功能檢測,血小板聚集力均出現(xiàn)不同程度的增加,ADP-PL-11顯示的范圍在45%-60%。(Table 2、Fig.2)缺血性腦卒中患者的血小板功能變化增加了卒中復(fù)發(fā)的風(fēng)險。3、發(fā)現(xiàn)約76例患者出現(xiàn)了血小板聚集功能“反跳”的變化并有33例存在缺血性卒中的再發(fā)。血小板反跳和缺血性卒中的復(fù)發(fā)存在顯著相關(guān)(P0.05)提示停服氯吡格雷、血小板功能和缺血性卒中之間存在某種相關(guān)性。結(jié)論:缺血性腦卒中患者停用氯吡格雷后存在血小板功能反跳,血小板功能的變化會增加缺血性腦卒中再發(fā)風(fēng)險的幾率。這意味著抗血小板藥的合理應(yīng)用對缺血性卒中的預(yù)防仍需引起進(jìn)一步的關(guān)注,對氯吡格雷的合理應(yīng)用提供重要的臨床指導(dǎo)價值。
[Abstract]:Objective: ischemic stroke is a kind of ischemic necrosis of brain tissue caused by various causes of cerebral blood supply disturbance. It is the most common multi-etiological disease in neurology department. Its prognosis is poor, the rate of death and disability is high. Bringing a heavy burden to patients' families and society is one of the biggest challenges facing the health and health of our country at this stage. The activation of platelets in the body. Adhesion and aggregation are closely related to the progress of the disease. Antiplatelet therapy is the basic treatment in secondary prevention of ischemic stroke. Clopidogrel is a phenothiopyridine antiplatelet drug with high safety in clinical application. Platelet function rebound was discovered in recent years after the interruption of clopidogrel treatment in patients with ischemic cardio-cerebrovascular disease. There was no prospective study to report a direct correlation between platelet activity rebound and adverse local ischemic events after antiplatelet drug discontinuation. Platelet function was monitored by PL-11 platelet function monitor. To analyze the relationship between clopidogrel and platelet function rebound, and the correlation between platelet function rebound and recurrent ischemic stroke. Methods: a total of 289 patients with ischemic stroke treated with clopidogrel from September 2014 to November 2015 in the Department of Neurology, Harrison International Peace Hospital, were collected and monitored. Patients with ADP adenosine diphosphate AA arachidonic acid) were followed up with clopidogrel and clopidogrel for various reasons. The platelet function test was carried out for at least 2 months to observe the correlation of platelet aggregation "rebound" or the occurrence of main end point events (Ischemia). The data were analyzed by 蠂 ~ 2 analysis with SPSS19.0 statistical software. Results 30 of 289 patients with clopidogrel resistance had clopidogrel resistance and 30 had clopidogrel resistance. It was found that about 8 patients with recurrent transient ischemic attack (TIA) or ischemic stroke (26. 7%), 259 cases with non clopidogrel "resistance" or low reaction (89. 6%) stopped taking clopidogrel for various reasons (economy, bleeding, lack of health education, etc.). The withdrawal rate was about 52.9, and the recurrence rate after withdrawal was 26.8kytabl1.2.The platelet function of patients who stopped taking clopidogrel for more than two months and two weeks and four weeks continued to be measured. Platelet aggregation increased in varying degrees; ADP-PL-11 showed a range of 45-60) changes in platelet function in patients with ischemic stroke, which increased the risk of stroke recurrence. It was found that about 76 patients had platelet aggregation. " There were 33 cases of recurrent ischemic stroke. There was a significant correlation between platelet rebound and recurrence of ischemic stroke (P0.05) indicating that clopidogrel was stopped. Conclusion: there is a platelet function rebound in patients with ischemic stroke after stopping clopidogrel. Changes in platelet function increase the risk of recurrent ischemic stroke. This means that rational use of antiplatelet drugs for the prevention of ischemic stroke needs further attention. It provides important clinical guidance value for the rational application of clopidogrel.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 孫彬;周杏;朱蕾;韓冰;杜光艷;劉欣欣;孫鵬;張曉萌;董梅;;新型血小板功能分析儀PL-11監(jiān)測血小板聚集功能的應(yīng)用價值[J];標(biāo)記免疫分析與臨床;2015年06期

2 黃四春;郭毅;;抗血小板在缺血性腦卒中治療中的應(yīng)用現(xiàn)狀[J];廣東醫(yī)學(xué);2013年19期

3 溫宏峰;王瑞彤;李繼來;;缺血性腦卒中患者阿司匹林或氯吡格雷及其聯(lián)合應(yīng)用抗血小板治療的研究[J];臨床神經(jīng)病學(xué)雜志;2013年03期

4 鄧娟;沈潔;姜安麗;;缺血性腦卒中患者二級預(yù)防護(hù)理干預(yù)現(xiàn)狀[J];中華護(hù)理雜志;2012年01期

，

本文編號：1615533