氯吡格雷联合阿司匹林双负荷剂量与常用剂量治疗急性非心源性脑梗死的临床效果比较

Comparison of clinical effect of clopidogrel combined with aspirin in double loading dosage and ordinary dosage in the treatment of acute non - cardiac cerebral infarction

目的评价双负荷剂量及常用剂量氯吡格雷联合阿司匹林在急性非心源性脑梗死治疗中的临床疗效和安全性。方法选取急性非心源性脑梗死患者110例按数字表法随机分为A和B两组,每组55例。A组采用双负荷剂量氯吡格雷联合阿司匹林治疗（第1天口服氯吡格雷300mg＋阿司匹林300mg,以后服用氯吡格雷75mg/d＋阿司匹林100mg/d）,B组采用常用剂量氯吡格雷联合阿司匹林治疗（氯吡格雷75mg/d＋阿司匹林100mg/d）。给药后7d评估脑梗死进展情况和NIHSS评分改善情况,记录不良反应发生情况。结果治疗后,A组脑梗死进展率为12.7%,B组脑梗死进展率为18.2%,A组低于B组（P=0.429）。A组治疗前NIHSS评分为（4.42±3.34）分,治疗7d后NIHSS评分为（3.15±2.58）分,治疗前后NIHSS评分差异有统计学意义（t=3.713,P〈0.01）。B组治疗前NIHSS评分为（4.16±2.76）分,治疗7d后NIHSS评分为（3.80±3.15）分,治疗前后NIHSS评分差异无统计学意义（t=1.209,P=0.232）。A组治疗前后NIHSS评分改善（1.27±2.54）分,B组治疗前后NIHSS评分改善（0.36±2.23）分,A组改善分值较B组多,差异有统计学意义（t=1.994,P=0.049）。治疗期间两组均未出现严重的不良反应。结论使用氯吡格雷联合阿司匹林治疗急性非心源性脑梗死,负荷剂量组比常用剂量组的脑梗死进展率低,但差异无统计学意义,负荷剂量组比常用剂量组在治疗早期NIHSS评分方面可有更好的改善。短期使用双负荷剂量或常用剂量氯吡格雷联合阿司匹林治疗急性非心源性脑梗死无明显不良反应。

Objective To study the clinical efficacy and safety of clopidogrel combined with aspirin in double loading dosage and ordinary dosage in the treatment of acute non - cardiac cerebral infarction. Methods A total of110 patients with acute non - cardiac infarction were equally assigned into two groups, each group had 55 patients. Thepatients in group A were treated with clopidogrel 300mg and aspirin 300mg on the 1st day, and followed by clopidogrel75mg and aspirin 100mg every day. Patients in group B were treated with clopdogrel 75mg and aspirin 100mg everyday. Clinical efficacy and safety were evaluated in one week, NIHSS scores were evaluated, and adverse effects wererecorded during treatment. Results After one week treatment, the deteriorate rates of group A and B were 12. 7%,18.2%. Compared with group B, group A had lower cerebral infarction deteriorate rate, but there was no statisticallysignificant difference（ P =0. 429） . After seven days treatment, the NIHSS score of A group had improved[ （ 4. 42 ±3 34） points vs. （ 3. 15 ±2. 58） points] , the difference was statistically significant（ t = 3. 713, P 〈 0. 01） , which ingroup B had no significant improvement[ （ 4. 16 ±2. 76） points vs. （ 3. 80 ±3. 15） points, t =1. 209, P =0. 232] . Afterseven days treatment, the NIHSS score improvement of group A was （ 1. 27 ± 2. 54） points, which of group B was（ 0 36 ±2 23） points, the difference was statistically significant（ t = 1. 994, P = 0. 049） . No severe adverse effectsoccurred in both two groups. Conclusion Using clopidogrel combined with aspirin in double loading dosage mayeffectively attenuate stroke process and improve prognosis than ordinary dosage. Using clopidogrel combined withaspirin had no severe adverse effects in short - term treatment of acute non - cardiac cerebral infarction.