双抗联合纤溶酶治疗急性缺血性脑卒中的量效学研究及预后危险因素分析  

Dose-effect study of dual antiplatelet therapy combined with plasmin in treatment of AIS and analysis of prognostic risk factors

作　　者：刘晓文 高永超 王少婵 刘晓慧 Liu Xiaowen;Gao Yongchao;Wang Shaochan;Liu Xiaohui(First Department of Neurology,Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,Hebei Province,China)

机构地区：[1]河北北方学院附属第二医院神内一科,张家口075100 [2]河北北方学院附属第二医院急诊科,张家口075100

出　　处：《中华老年心脑血管病杂志》2022年第6期618-621,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河北省2020年度医学科学研究课题计划项目(20200497)。

摘　　要：目的比较双抗联合纤溶酶对急性缺血性脑卒中(AIS)的临床疗效,并探讨影响患者预后的危险因素。方法选取2019年1月~2020年12月在我院就诊的240例拒绝溶栓治疗的轻型AIS患者,根据随机数字表法分为对照组、联合Ⅰ组、联合Ⅱ组,每组80例。对照组进行阿司匹林、氯吡格雷双抗治疗,联合Ⅰ组在此基础上静脉滴注100 U纤溶酶,联合Ⅱ组在此基础上静脉滴注200 U纤溶酶。治疗14 d后比较美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数量表(BI)评分、凝血功能四项指标和脑血流速度。90 d后进行随访,以改良的Rankin量表(mRS)≤1分为预后良好,mRS评分>1分为预后不良。用logistic回归分析预后不良的危险因素。结果治疗后3组NIHSS评分显著下降,BI评分显著升高(P<0.01);与对照组比较,治疗后联合Ⅰ组和联合Ⅱ组NIHSS评分、纤维蛋白原显著降低,BI评分、凝血酶原时间、活化部分凝血活酶时间、凝血酶时间显著增高;联合Ⅱ组NIHSS评分低于联合Ⅰ组,联合Ⅱ组BI评分高于联合Ⅰ组(P<0.05)。多因素logistic回归分析显示,年龄>70岁(OR=1.833,95%CI:1.016~3.307,P=0.044)、病程>6 h(OR=3.165,95%CI:1.267~7.904,P=0.014)、高血压(OR=2.440,95%CI:1.477~4.030,P=0.000)是轻型AIS患者预后不良的独立危险因素,双抗联合纤溶酶治疗(OR=2.912,95%CI:1.546~5.485,P=0.001)是AIS预后不良的独立保护因素。结论纤溶酶联合双抗能显著改善AIS患者的神经功能,提高脑部动脉血液循环,改善预后,是其不良预后的保护因素,并具有良好的安全性。Objective To compare the clinical effectiveness of dual antiplatelet therapy combined with plasmin in treatment of patients with acute ischemic stroke(AIS)and investigate the risk factors for prognosis.Methods A total of 240 patients with mild AIS who rejected thrombolysis in our hospital from January 2019 to December 2020 were enrolled in this study.They were randomly divided into control group,joint groupⅠand joint groupⅡ,with 80 cases in each group.The control group was treated with aspirin and clopidogrel,the joint groupⅠwas given an additional intravenous infusion of 100 U plasmin,and the joint groupⅡwas given an additional 200 U plasmin.After 14 days􀆳treatment,National Institutes of Health Stroke Scale(NIHSS),Barthel index(BI)scale,4 indexes of coagulation function,and cerebral blood flow velocity were compared among the 3 groups.The patients were followed up for 90 d.The improved modified Rankin Scale(mRS)≤1 was regarded as good prognosis,and the mRS score>1 as poor prognosis.Univariate and multivariate logistic regression analyses were used to analyze the risk factors for poor prognosis.Results After treatment,their NIHSS scores were significantly decreased,and BI scores were increased(P<0.01).When compared with the control group,the NIHSS scores and fibrinogen were significantly decreased,and the BI score,prothrombin time,activated partial thromboplastin time and thrombin time were significantly improved in joint groupⅠand joint groupⅡ.The joint groupⅡhad obviously lower NIHSS score but higher BI score than the joint groupⅠ(P<0.05).Multivariate logistic regression analysis indicated that age>70 years(OR=1.833,95%CI:1.016-3.307,P=0.044),course of disease>6 h(OR=3.165,95%CI:1.267-7.904,P=0.014)and hypertension(OR=2.440,95%CI:1.477-4.030,P=0.000)were independent risk factors for poor prognosis in mild AIS patients,and dual antiplatelet therapy combined with plas-min(OR=2.912,95%CI:1.546-5.485,P=0.001)was an independent protective factor for poor prognosis.Conclusion Dual antiplatelet th

关 键 词：卒中 阿司匹林 组织型纤溶酶原激活物 纤维蛋白 高血压 

分 类 号：R743.3[医药卫生—神经病学与精神病学]