阿替普酶联合抗血小板综合方案对急性缺血性轻型脑卒中患者症状改善及安全性的影响

The effect of antiplatelet combined with alteplase on symptom improvement and safety in patients with acute ischemic mild stroke

目的研究阿替普酶联合抗血小板综合方案对轻型急性缺血性脑卒中(AIS)患者症状改善及安全性的影响.方法选取2018年6月-2020年9月于山东省单县东大医院接受诊治的90例轻型AIS患者作为研究对象.将其以随机抽签法等分为联合组及参照组.参照组予以阿替普酶静脉溶栓治疗,且在治疗后采用阿司匹林长期治疗.联合组则予以阿替普酶静脉溶栓治疗、且在治疗后采用阿司匹林与氯吡格雷联用方案持续治疗3周,之后继续单独采用阿司匹林长期治疗.分别比较两组临床疗效、治疗前后神经功能缺损情况以及意识状态、不良反应控制效果、治疗前后血清炎症因子水平.结果联合组总有效率高于参照组(P<0.05).治疗后联合组NIHSS评分低于参照组,而GCS评分高于参照组(均P<0.05).联合组与参照组在无症状性脑出血、皮肤出血、血尿、牙龈出血发生率方面对比均不显著(均P>0.05).治疗后联合组各项血清炎症因子水平低于参照组(均P<0.05).结论阿替普酶与抗血小板联合治疗轻型AIS的临床疗效显著,有利于促进患者神经功能以及意识状态的恢复,同时有利于减轻炎症反应,具有较好的安全性,值得临床推广应用.

Objective To study and analyze the effect of combination of alteplase and antiplatelet on symptom improvement and safety in patients with mild acute ischemic stroke(AIS).Methods 90 cases of light AIS patients who received treatment in our hospital from June 2018 to September 2020 were selected as the research ohjects.They were divided into the combined group and the control group by random drawing.The control group was treated with alteplase intravenous thrombolytic therapy and aspirin long-term therapy.The combined group received intravenous thrombolytic therapy with atepase,and the combination of aspirin and clopidogrel was used for 3 weeks afier the treatment,followed by long-term treatment with aspirin alone.The clinical efficacy of the two groups was compared,including the neurological functional defects before and after treatment,the state of consciousness,the effects of adverse reaction control,and the levels of serum inflammatory factors before and after treatment.Resul ts The total effective rate of the combined group was higher than that of the control group(P<0.05).After treatment,the NIHSS score of the combined group was lower than that of the control group,while the GCS score was higher than that of the control group(all P<0.05).There was no significant difference in the incidence of asymptomatic cerebral hemorrhage,skin hemorrhage,hematuria and gingival hemorrhage between the combined group and the control group(all P>0.05).After treatment,the levels of inflammatory cytokines in the combined group were lower than those in the control group(all P<0.05).Conclusion Combined treatment of ateptase and antiplatelet for the treatment of light AIS has significant clinical efficacy,which is conducive to the recovery of patients'neurological function and consciousness,as well as the reduction of inflammatory reaction.It has good safety and is worthyof clinical application.