抗血小板聚集药物及他汀在脑梗死二级预防中的应用情况及对脑梗死复发的影响

The clinical application of antiplatelet therapy and stains for secondary prevention and its influence on recurrence in patients with cerebral infarction

目的了解脑梗死患者二级预防中抗血小板聚集药物及他汀的应用情况、中断治疗的原因及脑梗死复发情况。方法观察2012年10月~2013年10月在上海长征医院及长征医院闸北分院神经内科就诊的180例初发脑梗死患者从脑梗死后1月到脑梗死后1年抗血小板药物及他汀的应用情况，并根据患者在长期的二级预防过程中是否规律服用抗血小板药物及他汀分为规律用药组（n=73）、单用抗血小板聚集药物组（n=80）、单用他汀组（n=9）、均未服用组（n=18），调查患者中断抗血小板药物及他汀的原因并比较4组患者脑梗死后1年的复发情况。结果180例脑梗死患者中断抗血小板聚集治疗共有27例（15％），原因分别为不良反应19例（70．4％）、担心不良反应而不愿服用6例（22．2％）、医师未建议及门诊医师未开医嘱2例（7．4％）；中断他汀治疗共有98例（54．4％），原因分别为不良反应13例（13．3％）、担心不良反应而不愿服用27例（27．6％）、医师未建议及门诊医师未开医嘱25例（25．5％）、检测指标正常而自行停用30例（30．6％）、经济原因3例（3．1％）；脑梗死后1年脑梗死复发情况分别为规律用药组复发8例（11．0％）、单用抗血小板聚集药物组复发17例（21．3％）、单用他汀组复发2例（22．2％）、均未服用组复发6例（33．3％）。结论脑梗死二级预防中抗血小板聚集药物应用较为普遍，他汀应用严重不足，抗血小板聚集联合他汀治疗脑梗死后复发率明显降低。

Objective To investigate the clinical application of antiplatelet therapy and stains for second-ary prevention, the reasons of interrupt therapy and its influence on recurrence in patients with cerebral infarction. Methods Observe the clinical application of antiplatelet therapy and stains from 1 months after infarction to 1 year after infarction in180 cases of patients with cerebral infarction in Changzheng Hospital and ZhaBei Central Hospital from October 2012 to 2013 October ; The cases were divided into 4 groups according to whether or not taking antiplatelet drugs and stains： compliance group（n = 73）, the group of only use antiplatelet drugs（n = 80）, the group of only use stains（n = 9） ,not use antiplatelet drugs and stains （n = 18）. The reasons of interrupt antiplatelet drugs and stains and the recurrence rate of four groups were investigated. Results All of 180 cases of patients with cerebral infarction, 27 cases interrupted antiplatelet therapy（15%）, the reasons for adverse response 70. 4%,in fear of adverse response 22. 2%, not of receive the advice of doctor 7. 4% respectively;98 cases interrupted stains （54. 4 %）, the reasons for adverse response 13. 3%,in fear of adverse response 27. 6 %, not of receive the advice of doctor 25. 5 %, interrupt when lipids were normal 30. 6 %, economic reasons 3.1% respectively. One year after infarction, 8 cases were relapsed in compliance group, 17 cases were relapsed in only use antiplatelet drugs group, 2 cases were relapsed in only use stains group, 6 cases were relapsed in not use antiplatelet drugs and stains group. Conclusions The uses of antiplatelet therapy were more significantly and stains were insufficient for secondary prevention in patients with cerebral infarction, the recurrence rate decreased significantly in the compliance group.