症状性脑动脉狭窄未行支架植入患者多类药物一体化治疗的研究

Researching on integration of multi-drug treatment in patients who did not stent with symptomatic cerebral artery stenosis

目的探讨症状性脑动脉狭窄未行支架植入患者多类药物一体化治疗方案的效果、终点事件及安全性。方法初发的症状性脑动脉狭窄患者1 126例,随机分为治疗组787例,对照组339例。治疗组给予个体化分层血压调治技术,联合抗血小板及分层下调治血糖、血脂、纤维蛋白原的多类药物小剂量一体化协同治疗。对照组给予降压、单纯阿司匹林抗血小板、降糖、降脂、降纤的治疗方案。比较两组治疗后3年和5年健康功能水平、责任颈动脉狭窄区斑块内部回声特征、终点事件、不良反应、依从性情况。结果治疗组3年和5年脑梗死发生和复发、心脏事件、出血性表现、低血糖的发生率均明显低于对照组6.0%vs 13.3%、9.5%vs 19.2%、5.8%vs 12.4%、1.9%vs 6.2%、2.3%vs 7.1%(P<0.01)。治疗组3年和5年健康功能水平均高于对照组(P<0.05);超声复查斑块均较对照组稳定(P<0.05);治疗后5年病死率低于对照组4.2%vs 7.4%(P<0.05)。两组头痛发生率差异有统计学意义(P<0.05)。对照组退出率高于治疗组13.6%vs 5.3%(P<0.01)。结论症状性脑动脉狭窄未行支架植入患者多类药物一体化治疗方案显著降低了脑梗死发生和复发、心脏事件、出血性表现和低血糖的不良反应,极大提高了功能健康水平,效果显著,使用安全,患者依从性好。

Objective To research the effect,end point event and security in patients who did not stent with symptomatic cerebral artery stenosis but conducted integration of multi-drug therapeutic schedule. Methods Early patients 1 126 cases who suffered from symptomatic cerebral artery stenosis,were randomly divided into treatment group 787 cases,control group 339 cases.The patients in treament group were given individualized modulation of blood pressure,combined antiplatelet,modulated blood sugar under stratification,lipids,fibrinogen integrated collaborative treatment with multi-drug and little dose.The patients in control group were given therapeutic schedule of lowering blood pressure,simple aspirin anti-platelet and lowering blood sugar,lipids,fibrinogen.Comparing the health function,characteristics of responsibility carotid artery stenosis patch,end point event,adverse reactions and compliance after three years,five years of treatment in two groups. Results The treatment group,in 3 and 5 years′ incidence of cerebral infarction recurrence,cardiac events,hemorrhagic manifestations and hypoglycemia were significantly lower control group,6.0% vs 13.3%,9.5% vs 19.2%,5.8% vs 12.4%,1.9% vs 6.2%,2.3% vs 7.1%（P0.01）.Treatment group in 3 and 5 years′ treatment had higher healthy function than control group（P0.05）,and the patch was more steady than that of control group through the ultrasonography re-examination（P0.05）.In treatment group,total mortality rate was significantly lower in 5 years after treatment than that of control group,4.2% vs 7.4%（P0.05）.Two groups had satistical difference in headache incidence（P0.05）.The withraw rate in control group was higher than that of treatment group,13.6% vs 5.3%（P0.01）. Conclusion Patients who did not stent with symptomatic cerebral artery stenosis and conducted integration of multi-drug therapeutic schedule reduced adverse reactions,such as the recurrence of cerebral infarction,cardiac events,hemorrhagic manifestations and hypoglycemia;the therapy greatly improves functional health with remarkable,secure effect,and good compliance.