抗血小板聚集药在血管造影阴性蛛网膜下腔出血应用中的风险探讨  

The risk assessment of antiplatelet medications in angiogram -negative subarachnoid hemorrhage

作　　者：张泰鹏[1] 肖海[1] 韦冲[1] 覃星悦[1] 刘秋弟[1] 

机构地区：[1]贵港市人民医院神经内科,广西壮族自治区贵港537100

出　　处：《中国基层医药》2016年第22期3416-3418,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨抗血小板聚集药是否增加蛛网膜下腔出血（SAH）发病后并发症及其与预后的相关性。方法回顾性分析行全脑血管造影证实为血管造影阴性的 SAH 患者420例，采用改良 Rankin 量表评分（mRS）评判预后。结果420例患者中，63例行脑血管造影确诊为自发性 SAH。有抗血小板聚集药使用史的患者中，血管造影阴性 SAH（18／63，28．6％）明显多于血管造影阳性 SAH 的患者（39／357，11．0％；P ＝0．001）。血管造影阴性 SAH 患者中，有抗血小板聚集药使用史的患者（20／63，31．7％）较无抗血小板聚集药使用史的患者（12／63，20．0％）发病后14 d 预后更差（P ＝0．017）。多因素分析显示，经校正性别、年龄、Hunt-Hess 评分后，抗血小板聚集药使用史仍然是预测不良预后的显著指标（OR ＝2．3，95％CI 1．15～5．88，P ＝0．029）。结论抗血小板聚集药与血管造影阴性 SAH 早期预后相关，但与长期预后无显著相关。将来的前瞻性研究应进一步证实。Objective The influence of antiplatelet medications on prognosis after non -aneurysmal subarachnoid hemorrhage（SAH）is unknown.This study aimed to evaluate the risk of antiplatelet mdications in devel-oping SAH.Methods 420 patients who underwent catheter cerebral angiography after presenting with nontraumatic SAH were included.Outcomes were assessed by using the modified Rankin scale.Results A total of 420 patients underwent catheter angiography for evaluation of SAH.Of these,63 cases （15%）were angiogram -negative.The fraction of patients presenting with angiogram -negative SAH as well as the frequency of antiplatelet use among these patients significantly increased during the study period.Antiplatelet use was more commonly associated with angiogram-negative SAH（18 /63,28.6%）than with angiogram -positive SAH（39 /357,11%;P =0.001）.At 14 days after presentation,poor outcome was significantly more frequent among patients who took antiplatelet agents （20 /63, 31.7%）than among those who did not（12 /63,20%;P =0.017）.Conclusion Antiplatelet medication use is asso-ciated with poor early,but not late,outcomes after angiogram -negative SAH.More studies are needed to confirm this association.

关 键 词：血小板聚集抑制剂 阴性反应 脑血管造影术 蛛网膜下腔出血 

分 类 号：R743.35[医药卫生—神经病学与精神病学]