急性期聯(lián)合抗血小板治療對進(jìn)展性缺血性卒中的安全性和效能評價
發(fā)布時間：2019-05-30 05:32
【摘要】：目的：在急性期聯(lián)合抗血小板治療對進(jìn)展性缺血性卒中的安全性和效能評價。 方法：對沈陽軍區(qū)總醫(yī)院2009年1月-2012年6月期間收治的301例缺血性腦血管病患者的臨床資料進(jìn)行回顧性分析。301例均為發(fā)病在72小時以內(nèi)，并經(jīng)頭CT或MRI被證實為缺血性腦血管病。所有患者均收入神經(jīng)內(nèi)科病房，并在入院時、癥狀加重時、入院后第14天進(jìn)行NIHSS評分。281例急性腦梗死患者采用2007年Han等提出的改良TOAST病因?qū)W分型。其中，20例為短暫性腦缺血發(fā)作，患者根據(jù)ABCD2評分標(biāo)準(zhǔn)進(jìn)行高、中、低分層�；颊唠S機(jī)分為負(fù)荷劑量組（首劑氯吡格雷300mg,次日改為阿司匹林和氯吡格雷聯(lián)合）和單一用藥組（單用阿司匹林）。2011年10月后加入另外一組：聯(lián)合用藥組（阿司匹林和氯吡格雷聯(lián)合）。其中負(fù)荷劑量組男116例，女14例，年齡36-86歲，平均為60.71±11.58；聯(lián)合用藥組男27例，女10例，年齡33-80歲，平均為61.72±11.55；單一用藥組男116例，女18例，年齡27-87歲，平均為61.01±12.25。負(fù)荷劑量組入院當(dāng)日給予口服氯吡格雷300mg負(fù)荷劑量，次日改為氯吡格雷75mg+阿司匹林100mg口服每天一次，聯(lián)用2周；單一用藥組于入院當(dāng)日服用拜阿司匹林300mg口服每天一次，聯(lián)用2周；聯(lián)合用藥組于入院當(dāng)日服用氯吡格雷75mg+阿司匹林100mg口服每天一次，聯(lián)用2周。2周后三組均改為常規(guī)預(yù)防劑量拜阿司匹林100mg口服每天一次。 結(jié)果：134例單藥組治療患者入院NIHSS評分為3.25±2.40，治療2周后NIHSS為1.96±2.16，治療前后比較有統(tǒng)計學(xué)意義（P＜0.001）；130例負(fù)荷劑量組治療患者入院NIHSS評分為3.95±2.81，治療2周后NIHSS為2.22±2.36，治療前后比較有統(tǒng)計學(xué)意義（P＜0.001）；37例聯(lián)合用藥組治療患者入院NIHSS評分為3.65±2.25，治療2周后NIHSS為2.11±2.29，，治療前后比較有統(tǒng)計學(xué)意義（P＜0.001）。20例TIA患者中，阿司匹林組1例發(fā)生卒中；281例腦梗死患者進(jìn)展36例，其中134例單藥組腦梗死患者發(fā)生進(jìn)展26例，130例負(fù)荷劑量組腦梗死患者發(fā)生進(jìn)展8例，37例聯(lián)合用藥組腦梗死患者發(fā)生進(jìn)展2例。其中單藥組82例大動脈粥樣硬化型腦梗死患者發(fā)生進(jìn)展23例（28.05%），負(fù)荷劑量組79例大動脈粥樣硬化型腦梗死發(fā)生進(jìn)展7例（8.86%），聯(lián)合用藥組31例大動脈粥樣硬化型腦梗死患者發(fā)生進(jìn)展2例（6.45%）。安全性方面：三組在治療期間，發(fā)生非致死性出血共7例，其中，負(fù)荷劑量組牙齦出血2例，泌尿系出血1例，皮膚粘膜出血1例；聯(lián)合用藥組牙齦出血1例；阿司匹林組中牙齦出血1例，皮膚粘膜出現(xiàn)1例。三組中均未發(fā)生致命性消化道大出血及顱內(nèi)出血，均未發(fā)生血細(xì)胞減少、凝血功能障礙、哮喘等其他不良反應(yīng)。 結(jié)論：1.對于缺血性卒中或TIA患者給予急性期抗血小板治療，治療后其神經(jīng)功能缺損評分明顯改善；2.在本研究，卒中和TIA后72小時以內(nèi)給予300mg負(fù)荷劑量的氯吡格雷和300mg阿司匹林是安全有效的；3.對于預(yù)防進(jìn)展性缺血性腦梗死，氯吡格雷負(fù)荷量后阿司匹林聯(lián)合氯吡格雷的聯(lián)合治療是一種安全有效的急性期抗血小板治療方案，與單一抗血小板治療相比，可顯著降低卒中復(fù)發(fā)和進(jìn)展性缺血性卒中的發(fā)生率，尤其是大動脈粥樣硬化型腦梗死進(jìn)展的發(fā)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R743.3
本文編號：2488565
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R743.3
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