發(fā)布時間：2018-05-29 21:23

  本文選題：椎動脈支架術(shù)后 + 再狹窄　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察阿托伐他汀鈣聯(lián)合應(yīng)用普羅布考對椎動脈支架成形術(shù)術(shù)后再狹窄的影響以及對炎癥因子高敏C-反應(yīng)蛋白(high sensitive C-reactive protein,hs-CRP)、外周血氧化型低密度脂蛋白(oxidized low density lipoprotein,ox-LDL)指標的影響,評價并比較與阿托伐他汀鈣治療對椎動脈支架成形術(shù)術(shù)后患者的臨床療效,進一步探究兩種藥物聯(lián)用在臨床應(yīng)用的安全性以及在預(yù)防缺血性腦血管病事件中的作用。方法:將2016年01月至2016年06月就診于邢臺市第三醫(yī)院神經(jīng)內(nèi)科并且行椎動脈支架成形術(shù)術(shù)后的患者共60例,隨機分為A組(阿托伐他汀鈣組)和B組(聯(lián)合治療組),每組各30例。兩組患者均給予健康教育、戒煙限酒、飲食指導(dǎo)以及改善生活方式,同時給予控制血壓、血糖等常規(guī)治療。A組患者給予阿托伐他汀鈣片20mg 1/晚治療,B組采用阿托伐他汀鈣片20mg 1/晚+普羅布考0.5g 2/日聯(lián)合治療。隨訪觀察6個月,分別于術(shù)后及術(shù)后1,3,6個月,行頸部血管超聲評估椎動脈支架術(shù)后再狹窄情況,并觀察治療前后血脂水平,hs-CRP以及ox-LDL水平的變化。在隨訪過程中,監(jiān)測患者肝、腎功能、心肌酶及心電圖,觀察有無腦卒中事件的再發(fā)并記錄不良反應(yīng)事件的發(fā)生情況。結(jié)果:1兩組支架術(shù)后再狹窄率的比較分別于術(shù)后及術(shù)后1,3,6個月,行頸部血管超聲評估椎動脈支架成形術(shù)術(shù)后支架部位再狹窄情況,觀察頸部血管內(nèi)徑及血流流速并比較兩組支架術(shù)后再狹窄率。于術(shù)后3個月,A、B兩組患者的再狹窄率為10%(3/30)和6.89%(2/29),差異無統(tǒng)計學(xué)意義;而術(shù)后6個月的再狹窄率分別為20%(6/30)和10.34%(3/29),差異有統(tǒng)計學(xué)意義(P0.05)。2兩組間腦卒中事件的再發(fā)率比較在術(shù)后6個月的隨訪時,A組中有3例再發(fā)腦卒中事件發(fā)生,而B組無再發(fā)腦卒中患者,差異具有統(tǒng)計學(xué)差異(P0.05)。3兩組治療前后hs-crp及ox-ldl水平變化的比較通過觀察術(shù)后及術(shù)后1、3、6個月兩組患者外周血中hs-crp及ox-ldl水平的變化,結(jié)果顯示:與治療前相比,兩組患者外周血hs-crp的水平均有不同程度的降低。與a組相比,b組外周血hs-crp及ox-ldl水平顯著下降,差異有統(tǒng)計學(xué)意義(p0.05)。4兩組患者血脂水平的變化組內(nèi)比較:與治療前比較,術(shù)后3、6個月的兩組患者外周血中tc、tg、ldl-c水平均明顯下降,差異有統(tǒng)計學(xué)意義(p0.05),a組的hdl水平較治療前升高,差異有統(tǒng)計學(xué)意義(p0.05),但b組的hdl水平較治療前無明顯變化(p0.05)。組間比較:治療前兩組患者外周血中的tc、tg、ldl-c、hdl水平無顯著性差異(p0.05);而治療6個月后,兩組間tc、tg、ldl-c水平的比較有統(tǒng)計學(xué)差異,與a組相比,b組的tc、tg、ldl-c及hdl水平顯著下降,差異均有統(tǒng)計學(xué)意義(p0.05)。5藥物安全性評價在隨訪過程中,觀察患者有無肌肉酸痛、疲勞,監(jiān)測患者肝、腎功能、心肌酶及心電圖,并記錄不良反應(yīng)事件的發(fā)生情況。a、b兩組患者不良事件的發(fā)生率分別為13.3%、10.3%,其中a組患者中有4例、b組中3例出現(xiàn)肝酶alt及ast的輕度升高,但升高均3倍正常值。統(tǒng)計結(jié)果顯示,兩組之間不良事件的發(fā)生率差異無統(tǒng)計學(xué)意義(p0.05)。6術(shù)后再狹窄危險因素的評估對術(shù)后發(fā)生再狹窄患者的一般臨床資料進行統(tǒng)計學(xué)分析,發(fā)現(xiàn)吸煙是造成再狹窄的危險因素,差異有統(tǒng)計學(xué)意義;而聯(lián)合用藥則降低了再狹窄的發(fā)病率(p0.05)。7多元logistic回歸分析多元回歸分析顯示吸煙及聯(lián)合用藥是影響再狹窄的獨立影響因素,其中聯(lián)合用藥是保護因素,降低了術(shù)后6個月再狹窄的發(fā)生率(p0.05)。結(jié)論:在本實驗的樣本內(nèi)數(shù)據(jù)得出結(jié)論:對于椎動脈支架成形術(shù)術(shù)后的患者,阿托伐他汀鈣聯(lián)合普羅布考治療能夠1)顯著調(diào)節(jié)患者的血脂水平;2)降低了椎動脈支架成形術(shù)術(shù)后的再狹窄率;3)使缺血性腦血管病患者的復(fù)發(fā)風(fēng)險有效降低,藥物不良事件的發(fā)生率較單用阿托伐他汀鈣治療并未明顯增加。
[Abstract]:Objective: To evaluate and compare the effects of atorvastatin calcium combined with probucol on restenosis after vertebral artery stenting and the effects on the high sensitive C-reactive protein (hs-CRP) and the oxidative low density lipoprotein (oxidized low density lipoprotein, ox-LDL) of peripheral blood (oxidized low density lipoprotein, ox-LDL). The clinical efficacy of atorvastatin calcium treatment for patients with vertebral artery stenting, and further explore the safety of the two drugs combined in clinical application and the role in the prevention of ischemic cerebrovascular disease. Methods: from 2016 from 01 months to 06 months of 2016 in the Department of Neurology in the Third Hospital of Xingtai and the vertebral artery branch. 60 patients were divided into group A (atorvastatin calcium group) and group B (combined treatment group), with 30 cases in each group. The two groups were given health education, smoking cessation limited, diet guidance and improvement of life style, and routine treatment of group.A patients with control blood pressure and blood sugar given by Atorvastatin Calcium Tablets 20mg 1/ late treatment. The B group was treated with Atorvastatin Calcium Tablets 20mg 1/ late + propucol 0.5g 2/ day combined treatment. Follow up observation for 6 months, respectively, after the operation and 1,3,6 months after the operation, to evaluate the restenosis of the vertebral artery stenting after the neck vascular ultrasound, and observe the changes of blood lipid level, hs-CRP and ox-LDL level before and after treatment. During the follow-up process, the patients were monitored. Liver, renal function, myocardial enzyme and electrocardiogram were used to observe the recurrence of stroke events and to record the occurrence of adverse events. Results: 1 two groups after stent restenosis were compared after the operation and 1,3,6 months after the operation. The cervical vascular ultrasound was used to evaluate the restenosis of the stent position after the vertebral artery stenting, and the cervical blood was observed. The internal diameter and flow velocity were compared with the two groups of stent restenosis. The restenosis rate was 10% (3/30) and 6.89% (2/29) in the A and B two groups after 3 months of operation, but the restenosis rate was 20% (6/30) and 10.34% (3/29) in the 6 months after the operation, and the difference was statistically significant (P0.05) the recurrence rate of the apoplexy events in the.2 two group. After 6 months of follow-up, there were 3 cases of recurrent stroke in group A, and no recurrent stroke in group B (P0.05) the difference of hs-CRP and ox-LDL before and after treatment in group.3 two was compared by observing the changes of hs-CRP and ox-LDL levels in peripheral blood of the two groups of patients after the operation and in the 1,3,6 months after the operation. Compared with before treatment, the level of hs-CRP in the peripheral blood of the two groups decreased in varying degrees. Compared with the a group, the level of hs-CRP and ox-LDL in the peripheral blood of the group B decreased significantly. The difference was statistically significant (P0.05) the changes in the level of blood lipid in the group of.4 two: compared with before the treatment, TC, TG, LD in the peripheral blood of the two groups of patients after the postoperative 3,6 months. The level of L-C decreased significantly (P0.05), and the level of HDL in group A was higher than that before treatment (P0.05), but there was no significant change in HDL level in group B (P0.05). There was no significant difference between the two groups of patients before treatment, and there was no significant difference in the level of TC, TG, LDL-C, and HDL level in the peripheral blood of the patients before the treatment, and two after 6 months of treatment, two The levels of TC, TG, and LDL-C were statistically different between groups. Compared with group A, TC, TG, LDL-C and HDL decreased significantly in group B. The difference was statistically significant (P0.05).5 drug safety assessment during the follow-up process, the patients had no muscle pain, fatigue, monitoring the liver, renal function, myocardial enzyme and electrocardiogram, and recorded adverse events. The incidence of adverse events in the two group of B two was 13.3%, 10.3%, of which 4 cases were in group A, 3 cases in group B had a slight increase in ALT and AST, but the rise and rise were all 3 times normal. The statistical results showed that there was no statistical difference between the two groups of adverse events (P0.05) the risk factors for restenosis after.6 operation. The general clinical data of patients with restenosis after operation were statistically analyzed, and it was found that smoking was a risk factor for restenosis, and the difference was statistically significant, while the incidence of restenosis was reduced by combined use of drugs (P0.05).7 multiple logistic regression analysis and multivariate regression analysis showed that smoking and combined use of drugs were independent of restenosis. The combined use of drugs was a protective factor and reduced the incidence of restenosis after 6 months of operation (P0.05). Conclusion: in the sample of this experiment, it is concluded that for patients after vertebral artery stenting, atorvastatin calcium combined with probucol treatment can significantly regulate the level of blood lipid in patients; 2) lower vertebral movement. The restenosis rate after stent angioplasty; 3) reduced the risk of recurrence of the patients with ischemic cerebrovascular disease, and the incidence of adverse drug events did not increase significantly compared with the treatment of atorvastatin alone.
【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】：2017
【分類號】：R651.12

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