卒中急性期和恢复期抗血小板聚集治疗对患者认知和功能结局的影响  

Effect of Antiplatelet Therapy on Cognitive and Functional Outcome in Acute and Convalescent Phases after Stroke

作　　者：张勇[1,2,3] 张振馨 杨百瑜 李延峰 张蕲[1] 徐涛[4] 

机构地区：[1]华中科技大学同济医学院梨园医院神经科,中国武汉430077 [2]中国医学科学院北京协和医院神经科,中国北京100730 [3]武汉大学人民医院神经科,中国武汉430060 [4]北京协和医院基础医学院流行病学和卫生统计学系,中国北京100005

出　　处：《国际老年医学杂志》2012年第4期145-149,共5页International Journal of Geriatrics

摘　　要：目的：研究急性缺血性卒中后给予抗血小板聚集治疗是否影响患者卒中后3个川的认知和功能结局。方法：住院期间，对卒中患者预筛，人口统计学、神经科体检和卒中后急性期和恢复期使用抗血小板聚集治疗情况被记录。卒中后3个月将有首发卒中和否认卒中前认知障碍的患者召回进行认知和功能结局的检查。首先对所有符合人组条件的患者用MOCA量表进行认知筛查，对存在可疑认知障碍的患者进一步行包括记忆力、视空间、执行功能和注意力等认知域的细查。依据细查的结果，卒中患者被诊断为卒中后认知障碍或者正常。在对性别、年龄、教育水平和卒中发生时的神经功能缺损进行调整后，运用多因素的logistic回归分析发现卒中急性期和恢复期使用抗血小板聚集治疗埘卒中后3个月的认知和功能结局是否存在影响。结果：本研究入组符合条件的患者总共453例，其中374（82．6％）例在卒中后48h内使用了抗血小板聚集治疗。单因素分析发现，急性期使用抗血小板药可明显改善卒中患者3个月后的认知和功能结局，而恢复期使用该疗法对卒中后3个月的结局无影响。调整后，仍然发现急性期使用抗血小板聚集治疗对卒中后3个月的认知（OR1．99，95％CI1．33～3．25）和功能结局（ORI．89，95％CI1．12～3．23）有积极的治疗作用。结论：卒中后48h内的抗血小板聚集治疗对卒中后3个月的认知和功能结局有积极的治疗作用。OBJECTIVE ： To investigate the effect of antiplatelet therapy on cognitive and functional outcome in acute and convatescent phases after stroke. METHODS： Hospitalized patients were prescreened and demographics, neurological examination and antiplatelet therapy in acute phases and convalescent phases after stroke were recorded. Patients with first - ever stroke and without pre - stroke cognitive impairment were recruited in 3 months after stroke in this study. For patients who failed to pass cognitive sereening, a battery of cognitive tests, evaluating memory, executive function, visuospatial and attention were performed. Based on the resultes of neuropsychological testing, patients were diagnosed as post - stroke cognitive impairment or normal cognition. Sex, age, education and neurological deficit at stroke onset were adjusted by multivariate logistic regression analyses. RESULTS： Antiplatelet treatment in acute stroke could improve cognitive and functional outcome in 3 months after stroke, but not at convalescence. The adjusted odds ratio for intact cognition was 1.92 （95% CI 1.13 to 3.25） and for favorable functional outcome 1.89 （95% CI 1.12 to 3.23）. CONCLUSION： Antiplatelet therapy in the first 48 hours after stroke is markedly associated with a favorable cognitive and tunctional outcome in 3 months after first - ever stroke.

关 键 词：卒中 抗血小板聚集治疗 认知 功能结局 

分 类 号：R743.31[医药卫生—神经病学与精神病学]