抗凝与双重抗血小板聚集治疗早期进展性脑梗死患者疗效比较分析
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摘要
目的比较抗凝与双重抗血小板聚集治疗早期进展性脑梗死患者的临床疗效。方法选择2014年4月至2017年4月我院收治的早期进展性脑梗死患者82例,按照入院顺序随机分为抗凝组和抗血小板组。在常规治疗的基础上,抗凝组患者给予低分子肝素钙抗凝治疗,抗血小板组患者给予双重抗血小板聚集治疗。比较两组患者的NIHSS评分、治疗14 d后的mRS评分和Barthel评分;比较两组的治疗总有效率和出血性并发症的发生情况。结果两组患者在治疗前、治疗1 d、治疗7 d、治疗14 d后的NIHSS评分比较差异有统计学意义(P <0. 05)。治疗7 d、14 d,抗凝组患者的治疗总有效率均显著高于抗血小板组,差异有统计学意义(P <0. 05);抗凝组患者的mRS评分显著低于抗血小板组,Barthel评分显著高于抗血小板组,差异有统计学意义(P <0. 05)。治疗期间,两组患者均未出现脑出血和消化道出血等出血性并发症。结论与双重抗血小板聚集治疗比较,对早期进展性脑梗死患者实施抗凝治疗效果更为显著,可更好地改善患者的神经功能缺损情况,恢复其生活能力,改善预后。
Objective To compare the clinical efficacy of anticoagulation and dual antiplatelet aggregation in the treatment of early progressive cerebral infarction. Methods A total of 82 patients with early progressive cerebral infarction admitted to our hospital from April 2014 to April 2017 were randomly divided into anticoagulation group and antiplatelet group according to the order of admission. On the basis of conventional treatment,the anticoagulant group was given low molecular weight heparin calcium anticoagulant therapy and the antiplatelet group was given double antiplatelet aggregation therapy. The NIHSS score,the mRS score and Barthel score of 14 days after treatment of the two groups were compared. The total effective rate of treatment and incidence of hemorrhagic adverse complications of the two groups were compared.Results There was significant difference in NIHSS scores between the two groups before treatment,1 day,7 days and 14 days after treatment( P < 0. 05). The total effective rates of anticoagulation group in 7 days and 14 days after treatment were significantly higher than those of antiplatelet group,the difference was statistically significant( P < 0. 05). The mRS score in the anticoagulation group was lower than that in the antiplatelet group,and Barthel score was higher than that in antiplatelet group,the difference was statistically significant( P < 0. 05). During the treatment period,no hemorrhagic complications such as cerebral hemorrhage and gastrointestinal bleeding occurred in the two groups. Conclusion Compared with double antiplatelet aggregation therapy,anticoagulant therapy is more effective in patients with early progressive cerebral infarction,which can better improve neurological deficits,restore their living ability and improve prognosis.
Objective To compare the clinical efficacy of anticoagulation and dual antiplatelet aggregation in the treatment of early progressive cerebral infarction. Methods A total of 82 patients with early progressive cerebral infarction admitted to our hospital from April 2014 to April 2017 were randomly divided into anticoagulation group and antiplatelet group according to the order of admission. On the basis of conventional treatment,the anticoagulant group was given low molecular weight heparin calcium anticoagulant therapy and the antiplatelet group was given double antiplatelet aggregation therapy. The NIHSS score,the mRS score and Barthel score of 14 days after treatment of the two groups were compared. The total effective rate of treatment and incidence of hemorrhagic adverse complications of the two groups were compared.Results There was significant difference in NIHSS scores between the two groups before treatment,1 day,7 days and 14 days after treatment( P < 0. 05). The total effective rates of anticoagulation group in 7 days and 14 days after treatment were significantly higher than those of antiplatelet group,the difference was statistically significant( P < 0. 05). The mRS score in the anticoagulation group was lower than that in the antiplatelet group,and Barthel score was higher than that in antiplatelet group,the difference was statistically significant( P < 0. 05). During the treatment period,no hemorrhagic complications such as cerebral hemorrhage and gastrointestinal bleeding occurred in the two groups. Conclusion Compared with double antiplatelet aggregation therapy,anticoagulant therapy is more effective in patients with early progressive cerebral infarction,which can better improve neurological deficits,restore their living ability and improve prognosis.
引文
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[11]尹魁明,肖爱玲.低分子肝素联合依达拉奉治疗进展性脑梗死的临床疗效及安全性[J].中国老年学杂志,2017,37(1):106-108.
[12]王东,张咏,潘金保,等.丁苯酞氯化钠注射液联合低分子肝素钙治疗急性进展性脑梗死的临床研究[J].卒中与神经疾病,2015,22(3):160-162.
[13]张春生,金辉,胡喜庆,等.溶栓、抗凝、抗血小板治疗与脑微出血及脑梗死后出血性转换的关系[J].脑与神经疾病杂志,2011,19(4):253-258.
[2]林朋兴,陈茂玉.联合抗血小板治疗进展性脑梗死疗效及安全性分析[J].国际医药卫生导报,2016,22(22):3468-3471.
[3]王新德.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[4]段洪连,刘美云,张拥波,等.缺血性脑卒中常用评估量表及其最新研究进展[J].中国全科医学,2011,14(35):4018-4021.
[5]Lai SM,Duncan PW.Stroke recovery profile and the Modified Rankin assessment[J].Neuroepidemiology,2001,20(1):26-30.
[6]戴海琳,王丽,王彦珍,等.丁苯酞氯化钠注射液联合双重抗血小板治疗进展性脑梗死的临床疗效观察[J].中国现代医学杂志,2015,25(33):95-97.
[7]张绪伟,李春华,于福恩,等.尤瑞克林联合胰岛素治疗进展性脑梗死合并高血糖状态的临床疗效观察[J].中国医药指南,2010,8(32):101-103.
[8]刘迪?,郭宏伟,皇甫留杰,等.大剂量氯吡格雷治疗进展性脑梗死34例临床观察[J].内科,2013,8(5):484-485.
[9]Kovács EG,Katona E,Bereczky Z,et al.New direct and indirect methods for the detection of cyclooxygenase 1acetylation by aspirin;The lack of aspirin resistance among healthy individuals[J].Thromb Res,2013,131(4):320-324.
[10]李穗生.进展性脑梗死患者联合应用阿托伐他汀与抗凝药物治疗的效果分析[J].中外医疗,2013,32(1):137-138.
[11]尹魁明,肖爱玲.低分子肝素联合依达拉奉治疗进展性脑梗死的临床疗效及安全性[J].中国老年学杂志,2017,37(1):106-108.
[12]王东,张咏,潘金保,等.丁苯酞氯化钠注射液联合低分子肝素钙治疗急性进展性脑梗死的临床研究[J].卒中与神经疾病,2015,22(3):160-162.
[13]张春生,金辉,胡喜庆,等.溶栓、抗凝、抗血小板治疗与脑微出血及脑梗死后出血性转换的关系[J].脑与神经疾病杂志,2011,19(4):253-258.