抗血小板聚集治疗与急性期脑梗死患者预后的关系及其影响因素分析  

The relationship between antiplatelet aggregation therapy and the prognosis of patients with acute cerebral infarction and its influencing factors analysis

作　　者：刘楠 白霞 赵津璋 LIU Nan;BAI Xia;ZHAO Jinzhang(Jiamusi Central Hospital,Jiamusi Heilongjiang 154002,China)

机构地区：[1]佳木斯市中心医院,黑龙江佳木斯154002

出　　处：《中国急救复苏与灾害医学杂志》2024年第11期1459-1462,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：黑龙江省卫生健康委科研课题(编号:20220303071156)。

摘　　要：目的 探讨抗血小板聚集治疗与急性期脑梗死患者预后的关系及其影响因素。方法 回顾性收集2021年2月—2023年2月于佳木斯市中心医院采用双联抗血小板药物治疗的急性期脑梗死患者60例(双抗组)临床资料,另匹配同时段采用单抗血小板药物治疗的急性期脑梗死患者60例为单抗组。比较两组患者入院时、治疗30 d、治疗6个月美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分量表(m RS)评分及出现出血不良反应概率。采用二元Logistic回归分析影响急性期脑梗死患者预后的因素。结果 与同组入院时相比,两组患者治疗30 d、治疗6个月NIHSS评分均降低,且双抗组NIHSS评分低于单抗组(均P<0.05)。与同组入院时相比,两组患者治疗30 d、治疗6个月m RS评分均降低,且双抗组m RS评分低于单抗组(均P<0.05)。单抗组1例患者出现牙龈出血、1例患者出现黑便,双抗组2例患者出现牙龈出血、1例患者出现鼻出血、1例患者出现脑梗死出血转化,两组患者出血不良反应发生率无显著差异(χ^(2)=0.702,P=0.402)。与预后良好组相比,预后不良好组纤维蛋白原(Fib)水平更高,存在脑卒中史占比更高,双抗治疗占比更少,入院时m RS评分更高(P<0.05)。Logistic回归分析显示抗血小板治疗方案、入院时m RS评分、Fib是影响急性期脑梗死患者预后的因素(P<0.05)。结论 抗血小板聚集治疗可改善急性期脑梗死患者预后,对于发病24 h以内的、NIHSS评分≤5分的急性脑梗死患者,双抗血小板聚集比单抗更能获得良好预后,并不增加出血风险。抗血小板治疗方案、入院时m RS评分、Fib是影响预后的因素。Objective To explore the relationship between antiplatelet aggregation therapy and prognosis of patients with acute cerebral infarction and analysis of influencing factors.Methods Clinical data of 60 patients with acute cerebral infarction treated with dual antiplatelet drugs in our hospital from February 2021 to February 2023 (two antiplatelet drug use groups) were retrospectively collected,and 60 patients with acute cerebral infarction treated with single antiplatelet drugs in our hospital at the same time were matched as the Single antiplatelet drug use group.The score of the National Institutes of Health Stroke Scale,the modified Rankin scale and the probability of adverse bleeding reaction were compared between the two groups at admission,30 days and 3 months after treatment.The factors affecting prognosis of acute cerebral infarction patients were analyzed by binary Logistic regression.Results Compared with the same group at admission,NIHSS scores in both groups were lower at 30 days and 6 months after treatment,and NIHSS scores in the two antiplatelet drug use groupswere lower than those in the Single antiplatelet drug use group (all P<0.05).Compared with the same group at admission,the m RS Scores of patients in both groups were lower at 30 days and6 months after treatment,and the m RS Scores in the two antiplatelet drug use groups were lower than those in the Single antiplatelet drug use group (all P<0.05).There was no significant difference in the incidence of adverse bleeding between the two groups (χ~2=0.702,P=0.402).In the Single antiplatelet drug use group,1 patient had gingival bleeding,1 patient had black stool,2 patients had gingival bleeding,1 patient had nosebleed and 1 patient had cerebral infarction hemorrhage transformation.Compared with the poor prognosis group,the level of Fibrinogen (Fib) in the good prognosis group was lower,the history of stroke was less,and the proportion of double-antibody therapy was more.Compared with the good prognosis group,the m RS Score of the poor prognosis gr

关 键 词：抗血小板聚集治疗 急性期脑梗死 预后 改良Rankin评分量表 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]