静脉溶栓后行双重抗血小板治疗轻型缺血性卒中患者效果观察  

Effect of dual antiplatelet therapy after intravenous thrombolysis in patients with mild ischemic stroke

作　　者：李虹[1] 陈娜[1] 陆连生[1] 卢海丽[1] 李婧[1] 王聪杰[1] 郑丽[1] 张斌[1] 宋巧[1] 史万英[1] LI Hong CHEN Na LU Liansheng LU Haili LI Jing WANG Congjie ZHENG Li ZHANG Bin SONG Qiao SHI Wanying.(Department of Neurology, Shijiazhuang First Hospital, Shijiazhuang 050011, China)

机构地区：[1]石家庄市第一医院神经内三科,050011

出　　处：《疑难病杂志》2017年第5期445-448,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省卫计委2015年度医学科学研究重点课题计划项目(20150919)

摘　　要：目的观察静脉溶栓后行双重抗血小板治疗轻型缺血性卒中患者的临床效果。方法选择2012年12月—2015年12月石家庄市第一医院神经内科住院治疗的轻型缺血性卒中患者114例作为研究对象,按治疗方式不同将其分为观察组(58例)和对照组(56例)。对照组给予静脉溶栓治疗后应用阿司匹林,观察组静脉溶栓治疗后给予双重抗血小板药物治疗3周,之后应用阿司匹林治疗。3个月后比较患者的疗效、功能评分、炎性因子,并统计出血率、病死率、复发率。结果观察组总有效率为96.6%高于对照组的75.0%,2组比较差异有统计学意义(x^2=5.484,P<0.05)。治疗后,观察组NIHSS、mRS评分低于对照组,而BI高于对照组,功能评分好转率较对照组高(P均<0.05)。与治疗前比较,2组治疗后hs-CRP、IL-6水平较治疗前降低,且观察组低于对照组(P均<0.05)。观察组炎性因子恢复正常比例高于对照组(P<0.05)。2组患者均未发生脑出血和病死情况,但对照组患者复发率为8.93%明显高于观察组的3.45%(x^2=5.543,P=0.019)。结论静脉溶栓后双重抗血小板治疗轻型缺血性卒中患者能够提高治疗效果,降低复发率,而且不会增加治疗风险。Objective To observe the therapeutic effect of intravenous thrombolysis on mild ischemic stroke and the safety of dual antiplatelet therapy after intravenous thrombolysis.Methods 114 patients with mild ischemic stroke who were treated in Department of Neurology,First Hospital of Shijiazhuang City from December,2012 to December,2015 were divided into 2 groups according to different treatment methods.The control group was treated with aspirin after intravenous thromblysis.The patients in treatment group were treated with intravenous thrombolysis on the basis of aspirin therapy.After 3 months,the curative effect of the patients,functional score and inflammatory factors was compared.The hemorrhage rate,mortality and recurrence rate were analyzed.Results The total effective rate of the observation group was 96.6%,which higher than that of the control group（75.0%）（P 〈0.05）.After treatment,the NIHSS and mRS scores in the observation group were lower than those in the control group,while BI increased（P 〈0.05）.After treatment,the levels of hs-CRP and IL-6 in the 2groups were lower than those before treatment,and the observation group was lower than the control group（P 〈0.05）.The recovery rate of inflammatory factors in the observation group was higher than that in the control group（P 〈0.05）.2 groups of patients with no cerebral hemorrhage and mortality,but the control group recurrence rate was significantly higher than the treatment group（8.93%vs.3.45%,x2=5.543,P =0.019）.Conclusion Intravenous thrombolysis can improve the therapeutic effect and reduce the recurrence rate in patients with mild ischemic stroke.The dual antiplatelet therapy after intravenous thrombolysis will not increase the treatment risk.

关 键 词：缺血性卒中 轻型 静脉溶栓 抗血小板 炎性因子 

分 类 号：R743.3[医药卫生—神经病学与精神病学]