本文選題：顱外頸動脈　切入點：支架　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:血管內(nèi)支架術(shù)已成為治療與預(yù)防缺血性腦卒中的重要措施,但顱外頸動脈支架術(shù)后對比單用阿司匹林或氯吡格雷長期抗血小板治療效果的研究較少,且不同Essen評分組間支架術(shù)后兩種抗血小板藥物的效果目前報道甚少。目的:通過1年的隨訪,對比顱外頸動脈支架術(shù)后單用阿司匹林或氯吡格雷不良終點事件的發(fā)生率,并比較不同Essen評分組間是否存在差異。方法:收集2014年1月至2015年1月于重慶醫(yī)科大學(xué)附屬第一醫(yī)院及第三軍醫(yī)大學(xué)附屬新橋醫(yī)院接受顱外頸動脈支架置入術(shù)的新發(fā)缺血性腦卒中患者219例,術(shù)后予以雙聯(lián)抗血小板(阿司匹林100mg/d及氯吡格雷75mg/d),應(yīng)用1個月(69例)或3個月(150例),然后單用阿司匹林(124例)100mg/d或氯吡格雷(95例)75mg/d。并對納入患者進行Essen評分,分為低危組(41例)及高危組(178例)。隨訪1年時的主要終點(同側(cè)腦梗死、非同側(cè)腦梗死、心肌梗死、死亡)及次要終點(顱內(nèi)或顱外出血)。結(jié)果:阿司匹林組與氯吡格雷組基線特征差異均無統(tǒng)計意義。隨訪1年時,阿司匹林組主要終點事件同側(cè)腦梗死、非同側(cè)腦梗死、心肌梗死、死亡發(fā)生率(分別為2.4%、0.8%、0.8%、0.0%)與氯吡格雷組發(fā)生率(分別為1.1%、0.0%、0.0%、0.0%)比較差異無統(tǒng)計學(xué)意義(P0.05)。阿司匹林組次要終點事件顱內(nèi)出血、顱外出血發(fā)生率(分別為1.6%、3.2%)與氯吡格雷組發(fā)生率(分別為1.1%、1.1%)比較差異亦無統(tǒng)計學(xué)意義(P0.05)。Essen評分低危組阿司匹林組主要終點事件同側(cè)腦梗死、非同側(cè)腦梗死、心肌梗死、死亡發(fā)生率(分別為4.3%、0.0%、0.0%、0.0%)與氯吡格雷組發(fā)生率(分別為0.0%、0.0%、0.0%、0.0%)比較差異無統(tǒng)計學(xué)意義(P0.05)。高危組阿司匹林組主要終點事件同側(cè)腦梗死、非同側(cè)腦梗死、心肌梗死、死亡發(fā)生率(分別為2.0%、1.0%、1.0%、0.0%)與氯吡格雷組發(fā)生率(分別為1.3%、0.0%、0.0%、0.0%)比較差異亦無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:顱外頸動脈支架術(shù)后雙聯(lián)抗血小板治療1或3個月后,單用阿司匹林或氯吡格雷抗血小板治療1年內(nèi)其主要終點事件及次要終點事件發(fā)生率無顯著差異。不同Essen評分組間兩種抗血小板藥物的主要終點事件亦無顯著差異。需要更大樣本的進一步研究。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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