【摘要】：目的:在不適合服用華法林的非瓣膜性心房顫動(NVAF)患者中,對比研究阿司匹林單藥治療與阿司匹林和雙嘧達莫聯(lián)合治療的有效性(血栓栓塞事件風險)及安全性(出血事件發(fā)生率),為我國(特別是邊遠貧困地區(qū))非瓣膜性房顫患者的抗凝治療提供新依據(jù)。方法:選擇于2012年7月至2014年5月在河北省第七人民醫(yī)院心內(nèi)科門診及住院的非瓣膜性房顫患者,按照入選標準共選擇198例CHADS2評分至少為1分的患者,隨機分為2組:阿司匹林聯(lián)合雙嘧達莫(聯(lián)合治療組)給予阿司匹林(100mg,每日一次)+雙嘧達莫(100mg,每日三次);阿司匹林組給予(100mg,每日一次)。門診隨訪察兩組血栓栓塞事件(缺血性腦卒中、外周動脈栓塞)、各種出血事件(顱內(nèi)出血、胃腸道、泌尿系、皮膚黏膜等出血)及其他不良反應的發(fā)生率,并比較它們之間的差異性。結(jié)果:1 198例NVAF患者中聯(lián)合治療組96例,阿司匹林組102例。各組患者一般資料比較(包括合并疾病及用藥)差異無統(tǒng)計學意義(P0.05)。2兩組患者CHADS2評分比較差異無統(tǒng)計學意義(P0.05),平均CHADS2評分為2.7分。3隨訪時間10~20(12±6)個月。兩組共脫落5例,其中聯(lián)合治療組脫落2例,阿司匹林組脫落3例。4聯(lián)合治療組發(fā)生缺血性腦卒中2例,周圍動脈栓塞3例;阿司匹林組發(fā)生缺血性腦卒中9例,其中1例死亡,急性心肌梗死1例,周圍動脈栓塞4例。聯(lián)合治療組缺血性腦卒中發(fā)生率明顯低于阿司匹林組(2.1%比9.1%P=0.04),總?cè)毖录陌l(fā)生率也明顯低于阿司匹林組(5.3%比14.1%P=0.04),差異有統(tǒng)計學意義。5兩組均無嚴重出血發(fā)生,聯(lián)合治療組發(fā)生輕微出血7例,阿司匹林組發(fā)生輕微出血4例,兩組比較差異無統(tǒng)計學意義(7.4%比4.0%P=0.31)。6聯(lián)合治療組發(fā)生頭痛11例,血小板減少1例,劍突下疼痛8例;阿司匹林組發(fā)生劍突下疼痛7例,以頭痛為主的不良反應聯(lián)合治療組高于阿司匹林組,差異有統(tǒng)計學意義(21.3%比7.1%P=0.005)。結(jié)論:對于CHADS2評分≥1分的非瓣膜性房顫患者,阿司匹林聯(lián)合雙嘧達莫預防血栓栓塞事件安全有效,優(yōu)于單純口服阿司匹林。
[Abstract]:Objective: in patients with non-valvular atrial fibrillation (NVAF) who are not suitable for warfarin, A comparative study of the efficacy (thromboembolic event risk) and safety (haemorrhage incidence) of aspirin monotherapy with aspirin and dipyridamole, which is non-valvular in China (especially in remote poor areas) To provide a new basis for anticoagulant therapy in patients with atrial fibrillation. Methods: a total of 198 patients with non-valvular atrial fibrillation were selected from July 2012 to May 2014 in the Department of Cardiology, Hebei Province Seventh people's Hospital. According to the inclusion criteria, a total of 198 patients with CHADS2 score of at least 1 were selected. They were randomly divided into two groups: aspirin combined with dipyridamole (100 mg, once a day) and aspirin group (100 mg, once a day). The incidence of thromboembolism events (ischemic stroke, peripheral artery embolism), various bleeding events (intracranial hemorrhage, gastrointestinal bleeding, urinary tract bleeding, skin and mucous membrane bleeding) and other adverse reactions were observed during outpatient follow-up. And compare their differences. Results among 1 198 cases of NVAF, 96 cases were treated with combined therapy and 102 cases were treated with aspirin. There was no significant difference in CHADS2 score between the two groups (P0.05). The average CHADS2 score was 2.7 points. 3. The follow-up time was 1020 (12 鹵6) months. There were 5 cases of abscission in both groups, 2 cases in combination group, 3 cases in aspirin group, 2 cases in ischemic stroke, 3 cases in peripheral artery embolism, 9 cases in aspirin group, 9 cases in aspirin group. One case died, one case had acute myocardial infarction and 4 cases had peripheral artery embolism. The incidence of ischemic stroke in the combined treatment group was significantly lower than that in the aspirin group (2.1% vs 9.1%P=0.04), and the incidence of total ischemic events was significantly lower than that in the aspirin group (5.3% vs 14.1%P=0.04). There were 7 cases of slight hemorrhage in the combined treatment group and 4 cases in the aspirin group. There was no significant difference between the two groups (7.4% vs 4.0%P=0.31) .6 in 11 cases of headache, 1 case of thrombocytopenia and 8 cases of subflagellate pain. There were 7 cases of subflagellate pain in aspirin group. The side effect of headache in combination group was higher than that in aspirin group (21.3% vs 7.1%P=0.005). Conclusion: aspirin combined with dipyridamole is safe and effective in preventing thromboembolic events in patients with non-valvular atrial fibrillation with CHADS2 score 鈮，

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