脑出血患者服用抗血小板药物的长期随访研究  

Long term following up of antiplatelet treatment in patients with intracerebral hemorrhage

作　　者：王丽平[1] 张新宇[1] 樊东升[1] 李小刚[1] 

机构地区：[1]北京大学第三医院神经内科,北京100191

出　　处：《中国医学前沿杂志（电子版）》2016年第2期81-84,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的研究脑出血患者长期随访过程中使用抗血小板药物与脑卒中复发的关系。方法筛选2008年至2011年本院神经内科诊治的脑出血患者138例为研究对象,脑出血后6个月内开始使用抗血小板药物治疗患者37例纳入早期抗血小板治疗组（使用的抗血小板药物均为阿司匹林肠溶片100mg/d或氯吡格雷75 mg/d）,未在脑出血后6个月内使用抗血小板药物治疗患者101例纳入非早期抗血小板治疗组,所有患者均随访36个月,并记录随访期两组患者抗血小板药物使用情况以及缺血性脑卒中和脑出血的发生情况;有条件的患者在随访满36个月时进行磁共振磁敏感加权成像（MRI-SWI）序列检查脑微出血情况,并采用MARS评分分级。结果随访完成时,早期抗血小板治疗组患者缺血性脑卒中（包括脑梗死和短暂性脑缺血发作）发生率为8.1%（3/37）,非早期抗血小板治疗组发生率为16.8%（17/101）,两组比较差异具有显著性（P=0.035）;早期抗血小板治疗组患者症状性脑出血发生率为2.7%（1/37）,非早期抗血小板治疗组发生率为3.0%（3/101）,两组比较差异无显著性（P=0.078）。87例患者完成了MRI-SWI检查,早期抗血小板治疗组患者MARS评分2~3级（代表较严重微出血）的比例为12.0%（3/25）,非早期抗血小板治疗组为9.7%（6/62）,两组比较差异无显著性（P=0.083）。结论脑出血后整体使用抗血小板药物进行缺血性脑卒中预防的比例较低,脑出血后6个月开始使用抗血小板药物治疗可以降低缺血性脑卒中发生风险,不明显增加症状性脑出血复发以及严重脑微出血。Objective To research the relationship between antiplatelet treatment and recurrent stroke in patients with intracerebral hemorrhage during long term following up. Method Total 138 cases were enrolled, which were divided into two group. There were 37 cases in early antiplatelet treatment group（accepted Aspirin 100 mg /Clopidogrel l75 mg per day within 6 months after onset of intracerebral hemorrhage）, and 101 cases in non early antiplatelet treatment group（did not accept antiplatelet treatment within 6 months after onset of intracerebral hemorrhage）. After enrollment, the usage of antiplatelet agents and occurrence of symptomatic hemorrhagic stroke and ischemic stroke were recorded. A part of subjective were scanned by MRI-SWI to determine situation of cerebral microbleeding. Result At the end of following up, statistic difference between the two groups occurred in probability of ischemic stroke（8.1% ︰ 16.8%, P = 0.035） and did not in morbidity of recurrent symptomatic intracerebral hemorrhage（2.7% ︰ 3.0%, P = 0.078） and cerebral microbleeding（12.0% ︰ 9.7%, P = 0.083）. Conclusion The antiplatelete treatment in patients with cerebral hemorrhage within 6 months after onset could reduce the chance of ischemic apoplexy and could not increase the ratio of recurrent intracerebral hemorrhage and severe cerebral microbleeding. However, this therapy is used such less in real clinical environment.

关 键 词：脑出血 阿司匹林 氯吡格雷 脑微出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]