不同剂量阿托伐他汀对急性脑梗死静脉溶栓后患者预后及症状性出血的比较研究  

Comparison on Prognosis and Symptomatic Bleeding of Different Doses of Atorvastatin in Patients with Acute Cerebral Infarction after Intravenous Thrombolysis

作　　者：孙巧松[1] 温清艳 李广生[1] 刁士元[1] 钟建新[1] 陈克强[1] 

机构地区：[1]广东省江门市中心医院,广东江门529000

出　　处：《中国医学创新》2017年第18期1-5,共5页Medical Innovation of China

基　　金：广东省江门市科技计划项目(2015002)

摘　　要：目的:研究不同剂量阿托伐他汀对急性脑梗死静脉溶栓后患者预后及症状性出血的效果。方法:选取2014年1月-2016年12月本院神经内科收治的住院并接受超早期静脉溶栓治疗(r-t PA)的急性脑梗死患者85例作为本次研究对象,采用随机数字表法或平行法将所有患者分为常规剂量组(20 mg/d)和高剂量组(40 mg/d),常规剂量组42例,高剂量组43例,所有患者入院后均予以常规对症治疗和静脉溶栓,常规剂量组在睡前口服阿托伐他汀20 mg,高剂量组在睡前口服阿托伐他汀40 mg,观察两组治疗前后NIHSS评分、溶栓结局(出血转化、脑实质出血、症状性颅内出血)、超敏-C反应蛋白(hs-CRP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)水平变化、溶栓后预后及生活质量改善情况。结果:治疗前两组NIHSS评分比较,差异无统计学意义(P>0.05),治疗后两组NIHSS评分均有显著下降,且高剂量组较常规剂量组明显(P<0.05);高剂量组脑实质出血率、症状性颅内出血率分别为9.30%、4.65%,均显著低于常规剂量组的28.57%、19.05%,差异均有统计学有意义(P<0.05);治疗前两组血清hs-CRP含量比较,差异无统计学意义(P>0.05),治疗后两组均有显著降低,且高剂量组血清hs-CRP含量低于常规剂量组(P<0.05);治疗前两组血清TC、TG、HDL-C、LDL-C比较,差异均无统计学意义(P>0.05),治疗后两组血清TC、TG、LDL-C较治疗前均有显著下降,血清HDL-C含量显著上升,且高剂量组均显著优于常规剂量组,差异均有统计学意义(P<0.05);常规剂量组预后良好率为33.33%,显著低于高剂量组的55.81%,常规剂量组m RS评分为(2.45±0.51)分,显著高于高剂量组的(1.95±0.24)分,差异均有统计学意义(P<0.05)。结论:高剂量阿托伐他汀静脉溶栓治疗急性心肌梗死较常规剂量可显著改善其血清炎症、血脂水平,同时可有效预防溶栓后脑实质出血、症状性颅内出血Objective：To study the effect of different doses of Atorvastatin on prognosis and symptomatic bleeding after intravenous thrombolysis in acute cerebral infarction.Method：A total of 85 patients with acute cerebral infarction who underwent advanced intravenous thrombolytic therapy（r-t PA） were enrolled in our hospital from January 2014 to December 2016.The patients were randomly divided into the conventional dose group（20 mg/d） and the high dose group（40 mg/d）,42 patients in the conventional dose group and 43 patients in the high dose group.All patients were treated with routine symptomatic treatment and intravenous solution after admission.The conventional dose group received Atorvastatin 20 mg before bedtime,the high dose group received 40 mg before bedtime.Before and after treatment,NIHSS score,thrombolytic outcome（hemorrhagic transformation,parenchymal hemorrhage,symptomatic intracranial hemorrhage）,serum hs-CRP,TC,TG,HDL-C,LDL-C levels,post-thalamectomy and improvement of quality of life of two groups were observed.Result：There was no significant difference in NIHSS score between two groups（P〉0.05）.After treatment,NIHSS scores of two groups were significantly decreased,and the high dose group was significantly higher than that of the conventional dose group,there were statistical significance（P〈0.05）.The rate of cerebral hemorrhage and symptomatic intracranial hemorrhage of the high dose group were 9.30% and 4.65%,which were significantly lower than 28.57% and 19.05% of the conventional dose group（P〈0.05）.After treatment,the level of hs-CRP of the high dose group was significantly lower than that of the conventional dose group（P〈0.05）,and there was no significant difference between two groups before treatment（P〉0.05）.There were no significant differences in serum TC,TG,HLD-C and LDL-C of two groups before treatment（P〉0.05）.After treatment,serum TC,TG and LDL-C of two groups were significantly decreased compared with those before treatment,and HDL-C was

关 键 词：阿托伐他汀 急性脑梗死 静脉溶栓 

分 类 号：R743.33[医药卫生—神经病学与精神病学]