阿司匹林联合氯吡格雷治疗缺血性脑卒中的临床研究
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摘要
目的观察阿司匹林联合氯吡格雷治疗缺血性脑卒中的临床疗效及安全性。方法将94例缺血性脑卒中患者随机分为对照组和试验组,每组47例。对照组给予阿司匹林治疗,首次300 mg,此后每次100 mg,口服,每天1次。试验组在对照组的基础上给予氯吡格雷治疗,首次300 mg,此后每次75 mg,口服,每天1次。2组均持续治疗21 d。比较2组患者的缺血性脑卒中再发率、颅内微出血(CMBs)发生情况、血小板聚集率、纤维蛋白原、血浆黏度、日常生活活动能力(ADL)评分和药物不良反应发生情况。结果治疗后,试验组和对照组缺血性脑卒中再发率分别为4. 26%(2例次/47例次)和17. 02%(8例次/47例次),差异有统计学意义(P <0. 05)。试验组和对照组颅内微出血发生率分别为21. 28%(10例次/47例次)和14. 89%(7例次/47例次),差异无统计学意义(P> 0. 05)。试验组和对照组血小板聚集率分别为(50. 42±5. 08)%和(55. 08±6. 75)%,纤维蛋白原分别为(3. 09±0. 53)和(3. 37±0. 66) g·L-1,血浆黏度分别为(1. 80±0. 27)和(2. 03±0. 23) m Pa·s,ADL分别为(49. 15±5. 82)和(42. 93±3. 74)分,差异均有统计学意义(均P <0. 05)。2组药物不良反应以恶心呕吐,皮疹,头痛为主,试验组和对照组药物不良反应发生率分别为25. 53%和14. 89%,差异无统计学意义(P> 0. 05)。结论阿司匹林联合氯吡格雷治疗缺血性脑卒中的效果优于阿司匹林单用,能够降低缺血性脑卒中再发率,改善日常生活活动能力,且未明显增加颅内微出血程度。
Objective To observe the clinical effect and safety of aspirin combined with clopidogrel in the treatment of patients with ischemic stroke. Methods Ninety-four patients with ischemic stroke were randomly divided into control group and treatment group,with 47 cases in each group. Control group was treated aspirin,300 mg for the first time and 100 mg thereafter,orally,qd. Treatment group was treated with clopidogrel on the basis of control group,clopidogrel 300 mg for the first time,75 mg thereafter,oral,qd. Both groups were treated for 21 d. The recurrent rates of ischemic stroke,cerebral microhemorrhage( CMBs)occurrence,platelet aggregation,fibrinogen,plasma viscosity,activity of daily living( ADL) score and adverse drug reactions in two groups were compared. Results After treatment,the recurrence rates of stroke in treatment group and control group were 4. 26%( 2 cases/47 cases) and17. 02%( 8 cases/47 cases),with significant difference( P < 0. 05). CMBs rates in treatment group and control group were 21. 28%( 10 cases/47 cases) and 14. 89%( 7 cases/47 cases),with no significant difference( P > 0. 05). The platelet aggregation rates in treatment group and control group were( 50. 42 ± 5. 08) % and( 55. 08 ± 6. 75) %,fibrinogen were( 3. 09 ± 0. 53) and( 3. 37 ± 0. 66) g·L-1,plasma viscosity were( 1. 80 ± 0. 27) and( 2. 03 ± 0. 23)m Pa·s,ADL were( 49. 15 ± 5. 82) and( 42. 93 ± 3. 74) points,all with significant difference( all P < 0. 05). The adverse drug reactions in both group were mainly nausea,vomiting,rash and headache,and the incidence of adverse drug reactions in treatment group and control group were 25. 53% and 14. 89%,with no significant difference( P > 0. 05). Conclusion Effect of aspirin combined with clopidogrel in the treatment of ischemic stroke is better than aspirin alone,which can reduce the recurrence rate,improve activity of daily living and doesn't significantly increase the degree of intracranial microhemorrhage.
Objective To observe the clinical effect and safety of aspirin combined with clopidogrel in the treatment of patients with ischemic stroke. Methods Ninety-four patients with ischemic stroke were randomly divided into control group and treatment group,with 47 cases in each group. Control group was treated aspirin,300 mg for the first time and 100 mg thereafter,orally,qd. Treatment group was treated with clopidogrel on the basis of control group,clopidogrel 300 mg for the first time,75 mg thereafter,oral,qd. Both groups were treated for 21 d. The recurrent rates of ischemic stroke,cerebral microhemorrhage( CMBs)occurrence,platelet aggregation,fibrinogen,plasma viscosity,activity of daily living( ADL) score and adverse drug reactions in two groups were compared. Results After treatment,the recurrence rates of stroke in treatment group and control group were 4. 26%( 2 cases/47 cases) and17. 02%( 8 cases/47 cases),with significant difference( P < 0. 05). CMBs rates in treatment group and control group were 21. 28%( 10 cases/47 cases) and 14. 89%( 7 cases/47 cases),with no significant difference( P > 0. 05). The platelet aggregation rates in treatment group and control group were( 50. 42 ± 5. 08) % and( 55. 08 ± 6. 75) %,fibrinogen were( 3. 09 ± 0. 53) and( 3. 37 ± 0. 66) g·L-1,plasma viscosity were( 1. 80 ± 0. 27) and( 2. 03 ± 0. 23)m Pa·s,ADL were( 49. 15 ± 5. 82) and( 42. 93 ± 3. 74) points,all with significant difference( all P < 0. 05). The adverse drug reactions in both group were mainly nausea,vomiting,rash and headache,and the incidence of adverse drug reactions in treatment group and control group were 25. 53% and 14. 89%,with no significant difference( P > 0. 05). Conclusion Effect of aspirin combined with clopidogrel in the treatment of ischemic stroke is better than aspirin alone,which can reduce the recurrence rate,improve activity of daily living and doesn't significantly increase the degree of intracranial microhemorrhage.
引文
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[6]谢燕贤,娄卫民.缺血性脑卒中患者阿司匹林或氯吡格雷及其联合应用抗血小板治疗的临床观察[J].中国医药导刊,2016,18(7):697-698.
[7]温宏峰,王瑞彤,李继来.缺血性脑卒中患者阿司匹林或氯吡格雷及其联合应用抗血小板治疗的研究[J].临床神经病学杂志,2013,26(3):180-182.
[2]蒲明军,陈军,杨伟业,等.阿司匹林联合氯吡格雷对缺血性轻度颈动脉狭窄患者脑卒中二级预防的作用[J].第三军医大学学报,2015,37(9):925-929.
[3]OZA R,RUNDELL K,GARCELLANO M.Recurrent ischemic stroke:strategies for prevention[J].Am Fam Physician,2017,96(7):436-440.
[4]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]段发亮,黄从刚,倪厚杰,等.阿司匹林联合氯吡格雷治疗缺血性脑卒中的疗效及对血小板聚集率的影响[J].中国临床神经外科杂志,2017,22(7):470-472.
[6]谢燕贤,娄卫民.缺血性脑卒中患者阿司匹林或氯吡格雷及其联合应用抗血小板治疗的临床观察[J].中国医药导刊,2016,18(7):697-698.
[7]温宏峰,王瑞彤,李继来.缺血性脑卒中患者阿司匹林或氯吡格雷及其联合应用抗血小板治疗的研究[J].临床神经病学杂志,2013,26(3):180-182.