大剂量阿司匹林联合阿托伐他汀钙对急性脑梗死患者临床疗效观察及对血栓弹力图和C反应蛋白的影响  

Large-dose Combination of Bayaspirin and Atorvastatin in the Treatment of Acute Cerebral Infarction:An Analysis of Clinical Effects,Elastic Parameters of Thrombus,and Plasma C-reactive Protein Level

作　　者：张西亭 杨琳琳 王祥森 

机构地区：[1]聊城市中心医院内科,聊城252000

出　　处：《中国卒中杂志》2017年第10期916-920,共5页Chinese Journal of Stroke

摘　　要：目的探讨急性脑梗死后第1周使用大剂量阿司匹林联合阿托伐他汀钙的临床疗效,观察血栓弹力图(thrombelastogram,TEG)和C反应蛋白(C-reactive protein,CRP)水平的变化。方法采用随机分组的方法将聊城市中心医院神经内科收治的急性脑梗死患者分为两组,大剂量组60例,对照组60例。大剂量组给予阿司匹林300 mg联合阿托伐他汀钙40 mg口服,1次/天,治疗7 d;后改为阿司匹林100 mg联合阿托伐他汀钙20 mg口服,1次/天,治疗7 d。对照组给予阿司匹林100 mg联合阿托伐他汀钙20 mg口服,1次/天,治疗14 d。同时,两组患者均给予相同的基础治疗,并适当对症治疗。所有患者治疗前及治疗14 d后均进行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、TEG和CRP检测。入院时行改良Rankin量表(modified Rankin scale,mRS)评分,随访3个月时进行mRS评分,评估两种治疗方案对于患者恢复情况的影响,并评估各组再发缺血性事件发生率。结果 (1)治疗14 d后,大剂量组NIHSS评分较对照组显著降低,比较差异有显著性(P<0.05);两组与治疗前相比,治疗14 d后NIHSS评分显著降低,比较差异有显著性(P<0.05)。(2)两组患者治疗14 d后,与治疗前相比,凝血反应时间(reaction time,R)、血细胞凝集块形成时间(kinetics of clot development,K)均长于治疗前,血细胞凝集块形成速率(α角)、最大血块强度(maximum intensity of blood clots,MA)均小于治疗前,比较差异有显著性(P<0.05);治疗14 d后,大剂量组和对照组比较,TEG各数值接近,比较差异无显著性。(3)治疗14 d后两组患者CRP水平均较治疗前明显降低,比较差异有显著性(P<0.05);治疗14 d后,大剂量组较对照组CRP降低更显著,比较差异有显著性(P<0.01)。(4)两组治疗前后mRS评分比较,差异有显著性(P<0.05);大剂量组与对照组治疗14 d后mRS评分比较,差异有显著性(P<0.05)。(5)3个月后随访,大剂量组有2例再发缺�Objective To study the first week after acute cerebral infarction using large-dose bayaspirin combined the clinical curative effect of atorvastatin calcium tablet, and to observe thrombus elastic graph（thrombelastogram, TEG） and c-reactive protein（CRP） level changes.Methods The randomized grouping was used to divide the patients with acute cerebral infarction in the department of neurology of Liaocheng City Central Hospital into two groups, namely, 60 cases in the large-dose group and 60 cases in the control group. The large dose group was given aspirin tablets of 300 mg of aspirin tablets and a total of 40 mg oral（international guidelines）, 1 time/d, lasting 7 days. After that, it was replaced with aspirin tablets 100 mg and combined with atorvastatin calcium tablets 20 mg, 1 time/d, lasting 7 days. The control group was treated with aspirin tablets 100 mg and combined with atorvastatin calcium 20 mg, 1 time/d, lasting 14 days. At the same time, both groups were given basic treatment and appropriate symptomatic treatment. All patients received the National Institutes of Health Stroke Scale（NIHSS） score, TEG and CRP detection before and after treatment of 14 d. The modified Rankin Scale（mRS） score at admission and at Month 3 follow up were evaluated to assess the influence of the two treatment options for patients with recovery and to assess recurrence rate of ischemic events in each group.Results（1） After treatment of 14 d, the NIHSS score of the large dose group was significantly lower than that in the control group（P〈0.05）, and the difference was statistically significant; the two groups were significantly reduced compared with the previous NIHSS scores before treatment（P〈0.05）, and the difference was statistically significant.（2） After treatment of 14 d, the coagulation reaction time,（reaction time, R） and haemagglutination block forming time（kinetics of clot development, K） were greater than that before the treatment, while haemagglutination block formation rat

关 键 词：急性脑梗死 阿司匹林 阿托伐他汀钙 血栓弹力图 C反应蛋白 

分 类 号：R743.33[医药卫生—神经病学与精神病学]