本文選題：抗血小板聚集　切入點(diǎn)：進(jìn)展性腦卒中　出處：《醫(yī)學(xué)研究生學(xué)報(bào)》2017年10期 　論文類型：期刊論文

【摘要】：目的阿司匹林聯(lián)合氯吡格雷雙抗血小板治療的方案在進(jìn)展性腦卒中的治療中已得到推廣,但相關(guān)指南對(duì)進(jìn)展性腦卒中抗血小板的方案仍無(wú)明確定論。文中觀察阿司匹林聯(lián)合氯吡格雷雙抗血小板對(duì)進(jìn)展性腦卒中患者腦血流動(dòng)力學(xué)以及血小板參數(shù)的影響。方法回顧性分析2014年1月至2016年1月期間于南京市腦科醫(yī)院住院的82例進(jìn)展性腦卒中患者(發(fā)病時(shí)間24 h)臨床資料,并按照治療情況分為單抗組(n=40)和雙抗組(n=42)。單抗組口服阿司匹林0.1 g/次,1次/d;雙抗組在口服阿司匹林的基礎(chǔ)上,另給予口服氯吡格雷75 mg/次,1次/d,治療21 d后改為單獨(dú)服用阿司匹林。入院第1、7天和3個(gè)月后分別評(píng)估患者的美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)得分以及生活自理能力巴氏指數(shù)(BI)。行經(jīng)顱多普勒檢查評(píng)估腦血流動(dòng)力學(xué)情況,使用血栓彈力圖儀檢測(cè)血小板抑制率,并檢測(cè)血小板計(jì)數(shù)(PLT)、血小板壓積(PCT)、平均血小板體積(MPV)、血小板體積分布寬度(PDW)等血小板參數(shù)。結(jié)果治療7 d和3個(gè)月后,雙抗組患者的NIHSS較單抗組顯著降低、BI得分較單抗組顯著上升(P0.05)。雙抗組在治療7 d后經(jīng)二磷酸腺苷(ADP)途徑誘導(dǎo)的血小板抑制率較單抗組顯著上升(P=0.003)。治療7 d后,雙抗組的PLT水平較單抗組明顯升高(P=0.006),MPV、PDW則較單抗組明顯下降(P=0.023、P=0.017);3個(gè)月后,雙抗組的PDW仍顯著低于單抗組(P=0.041)。治療7 d后,雙抗組雙側(cè)大腦中動(dòng)脈收縮期峰值血流速度Vs、平均血流速度Vm較單抗組下降(P0.05)。3個(gè)月后,雙抗組的Vs、脈動(dòng)指數(shù)PI較單抗組進(jìn)一步改善(P0.05)。結(jié)論阿司匹林聯(lián)合氯吡格雷雙抗血小板可改善進(jìn)展性腦卒中患者的腦血流動(dòng)力學(xué)和血小板參數(shù),從而改善臨床療效,效果優(yōu)于阿司匹林單抗。
[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.
【作者單位】： 南京醫(yī)科大學(xué)附屬腦科醫(yī)院腦血管病救治中心;南京醫(yī)科大學(xué)附屬兒童醫(yī)院新生兒醫(yī)療中心;
【分類號(hào)】：R743.3

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