预防脑梗死再发联合治疗方案5年对照研究  

Comparison study of combination therapy to prevent recurrent brain infarction in five years

作　　者：王连芹 宁海春 魏玉清 赵丽娟 王贵玲 王雪霞 何福岭 李国锋 沈惠峰 孔咏梅 

机构地区：[1]邢台市第三医院脑血管病治疗中心,河北邢台054000

出　　处：《临床荟萃》2010年第2期93-97,共5页Clinical Focus

基　　金：河北省2006年科学技术研究与发展指导计划项目(06276102D-16)

摘　　要：目的探讨预防脑梗死再发联合治疗方案的效果、终点事件发生及安全性的对照研究。方法初发性脑梗死患者978例,随机分为治疗组626例,对照组352例,治疗组给予个体化血压调治技术,联合抗血小板治疗及危险分层下小剂量辛伐他汀达标,三大类药物构成一体化的治疗方案。对照组给予降压、单纯阿司匹林抗血小板及危险分层下小剂量辛伐他汀达标的治疗方案。比较两组3年和5年后脑梗死再发率、终点事件发生率、不良反应及依从性情况。结果治疗组治疗后3年和5年脑梗死再发率、心脏事件发生率均明显低于对照组,5.4%vs 13.6%、7.8%vs21.0%、5.8%vs 11.6%(P<0.01),治疗后5年总病死率低于对照组,4.2%vs 7.1%(P<0.05)。治疗组治疗后3年和5年功能健康水平均高于对照组(P<0.05)。治疗组头痛发生率高于对照组(P<0.05)。两组脑出血、肝酶升高、消化道出血、癌症的发生率差异均无统计学意义(P>0.05)。对照组退出率高于治疗组,13.6%vs 5.3%(P<0.01)。结论预防脑梗死再发联合治疗方案,在脑梗死二级预防中能显著降低脑梗死再发率、心脏事件发生率和病死率,极大的提高了功能健康水平。患者对药物依从性好,而且安全性也好。Objective To explore the effect,safety and endpoint events in the combined treatment for prevention of recurrent brain infarction. Methods Nine hundred and seventy eight patients with brain infaction were enrolled and 626 cases were randomized in treatment group, 352 cases in control group. The treatment group was treated with individual adjustment-treating hypertention, combined with anti-platelet and low dosage of simvastatin for targeting goal of cholesterol-lowering on risk stratification. The control group was treated with reducing hypertension,aspirin to antiplatelet and lower dose simvastatin .for targeting goal of cholesterol-lowering on risk stratification. The 3 years＂ and 5 years＂ recurrence of brain infarction, the endpoint events, adverse reaction and compliance between two groups were compared. Results The treatment group showed lower recurrence after treatment for 3 years and 5 years,lower heart disease rate than control group,5.4% vs 13.6%,7.8% vs 21.0%,5.8% vs 11.6%（ P 〈0.01）. The treatment group had lower mortality of 5 years than control group,4.2% vs 7.1% （ P〈0.05）. The treatment group displayed higher level of functional health after treatment of 3 years and after 5 years than control group （ P 〈0.05）. The rate of headache in treatment group was higher than that of control group（ P 〈0.05）. The rate of brain hemorrhage,elevated liver enzymes and muscle enzymes, gastrointestinal bleeding and cancer between two groups were no statistic significance（ P〈0.05）. The exit rate of the control group was higher than that of treatment group, 13.6% vs 5.3% （P 〈0.01 ）. Canclusion The combined treatment for prevention of recurrent brain infarction can reduce the recurrence of brain infarction, heart disease and the mortality, improve the level of functional health. The drugs have ideal compliance and safety for the patients.

关 键 词：脑梗塞 药物疗法 联合 病人依从 二级预防 终点事件 个体化达标 

分 类 号：R743.33[医药卫生—神经病学与精神病学]