不同抗血小板聚集治疗方案对高原缺血性卒中治疗对比研究

Comparative Study of Different Antiplatelet Therapy on Treatment of High Altitude Ischemic Stroke

目的研究应用不同的抗血小板聚集治疗方案对高原缺血性卒中临床治疗效果的影响。方法收集青海省人民医院神经内科自2014年3月-2015年3月收治的发病24 h内的急性缺血性卒中患者90例,随机分为阿司匹林单药治疗组和氯吡格雷联合阿司匹林治疗组,两组患者均进行相应的内科综合治疗,其中阿司匹林单药治疗组在前者基础上服用阿司匹林(100 mg/d),氯吡格雷和阿司匹林联合治疗组则在综合治疗的基础上采用氯吡格雷-阿司匹林联合治疗方案(阿司匹林100 mg/d,氯吡格雷75 mg/d),对比两组患者治疗后14 d和28 d美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分变化情况、进展性卒中发生率以及出血转化率和死亡率情况。结果两组治疗后比同组治疗前NIHSS均有显著降低,联合治疗组治疗后14 d及28 d NIHSS评分为5(3,7)和4(3,6),显著低于单药治疗组同期NIHSS评分[7(5,9)和6(4,8)](P分别为0.03和0.02)。联合治疗组中进展性卒中发生率为11.1%(5例),显著低于单药治疗组的35.5%(16例)(P=0.04)。两组28 d内缺血性卒中后出血转化率及死亡率方面无显著差异。结论氯吡格雷联合阿司匹林治疗方案表现出对急性高原性缺血性卒中良好的治疗效果,且不增加出血转化的风险。

Objective To explore the effects of different antiplatelet therapies on treatment of high altitude ischemic stroke. Methods A total of 90 patients with acute ischemic stroke within 24 h after onset admitted by Dept. of Neurology of Qinghai People’s Hospital during March, 2014 and March, 2015 were enrolled into study and were randomly divided into two groups. Patients in both groups received correspondent comprehensive internal medicine treatment. The control group was treated with aspirin （100 mg/d）, and the observation group were treated with Polivy-aspirin combination therapy （Polivy 75 mg/d, aspirin 100 mg/d）. The corresponding National Institutes of Health Stroke Scale （NIHSS） score changes at 14 d and 28 d after treatment, progressive stroke and the incidence of post infarction hemorrhage rate and mortality, clinical efifcacy analysis of two groups were compared. Results The post-treatment NIHSS of both groups were signiifcantly reduced compared with NIHSS before treatment. However, the NIHSS of the observation group after treatment at 14 d and 28 d were 5 （3, 7） and 4 （3, 6）, which was signiifcantly lower than NIHSS of the control group （P=0.03,P=0.02, respectively）. In terms of progressive stroke occurrence, the occurrence rate of the observation group after treatment was only 11.1% （5 cases）, which was signiifcantly lower than that of the control group of 35.5% （16 cases） （P=0.04）. There were no signiifcant differences in hemorrhage conversion rate and mortality rate within 28 d after ischemic stroke. 〈br〉 Conclusion Polivy-aspirin combination therapy has good therapeutic effect on high altitude acute ischemic stroke with no increase of risk of hemorrhage conversion.