发病前使用过抗血小板药物对急性缺血性脑卒中患者静脉溶栓疗效的影响  

Efficacy and safety of antiplatelet therapy prior to intravenous thrombolysis in acute ischemic stroke patients

作　　者：黄银辉[1] 李明媚 林友榆 杨美丽[3] 许盈盈[3] 卓识途 陈振杰 李隽静 张碧月[3] 蔡若蔚[3] 

机构地区：[1]福建省晋江市医院神经内科,福建晋江362000 [2]安溪县铭选医院神经内科,福建安溪362000 [3]福建医科大学:附属第二医院神经内科,福建泉州362000 [4]附属泉州第一医院神经内科

出　　处：《第三军医大学学报》2014年第3期287-291,共5页Journal of Third Military Medical University

摘　　要：目的探讨发病前使用过抗血小板药物治疗的急性缺血性脑卒中患者静脉溶栓治疗的疗效及安全性。方法从2006年4月到2012年11月连续收集发病6 h内静脉溶栓治疗的急性缺血性脑卒中患者作为研究对象。根据发病前有无使用过抗血小板药物治疗将上述患者分为使用过抗血小板药物组和未使用过抗血小板药物组。采用改良的Rankin量表评价神经功能恢复状况。结果 181例患者中发病前使用过抗血小板药物的溶栓治疗组34例,未使用过抗血小板药物的溶栓治疗组147例。两组在90 d内溶栓预后良好率(47.06%vs 57.82%,P=0.255)、颅内出血的发生率(11.76%vs 6.12%,P=0.251)、症状性颅内出血的发生率(8.82%vs 4.08%,P=0.252)及病死率(8.82%vs 4.76%,P=0.350)均无统计学差异。Logistic多因素回归分析显示溶栓前头颅CT有早期缺血改变、溶栓前NIHSS评分是症状性颅内出血的危险因素,溶栓前头颅CT早期缺血改变、溶栓前NIHSS评分、溶栓前血糖、溶栓前收缩压、症状性颅内出血是影响溶栓预后的因素。结论发病前使用过抗血小板药的急性缺血性脑卒中患者静脉溶栓治疗安全、有效。Objective To explore that the efficacy and safety of antiplatelet （AP） therapy prior to intravenous thrombolysis in acute ischemic stroke patients. Methods The patients with acute ischemic stroke who received intravenous therapy within 6 h from symptom onset were included, from April 2006 to November 2012. According to the prior use of AP drugs, a total of 181 patients were divided into AP drugs-treated group （AP group, n =34） and no AP drugs-treated group （no AP group, n = 147）. Modified Rankin scale was used to evaluate the recovery of neurological functions. Results There was no significant difference in efficacy （47.06% vs 57.82%, P = 0.255）, intracranial hemorrhage （ 11.76% vs 6.12%, P = 0. 251 ）, symptomatic intracranial hemorrhage （8.82% vs 4.08%, P =0.252） and mortality rate （8.82% vs 4.76%, P =0. 350） between the two groups. Logistic regression analysis showed that high baseline NIHSS score and early ischemic changes （EICs） on brain CT were related to intracranial hemorrhage independently. No early ischemic changes on brain CT, lower blood glucose level, lower systolic blood pressure level, and lower baseline NIHSS score were related to good outcome independently. Conclusion patients with intravenous thrombolvsis therapy is safe and The prior use of AP drugs in acute ischemic stroke effective.

关 键 词：发病前使用过抗血小板药物 急性缺血性脑卒中 溶栓 疗效 

分 类 号：R453.9[医药卫生—治疗学] R743.305[医药卫生—临床医学]