阿司匹林联合氯吡格雷治疗急性脑梗死并脑微出血的临床疗效

Clinical Effect of Aspirin Combined with Clopidogrel in Treating Acute Cerebral Infarction Patients Complicated with Cerebral Microbleeds

目的观察阿司匹林联合氯吡格雷治疗急性脑梗死并脑微出血的临床疗效。方法选取2015年5月—2016年5月延安大学咸阳医院收治的急性脑梗死并脑微出血患者76例,采用随机数字表法分为对照组与观察组,每组38例。在常规治疗基础上,对照组患者予以阿司匹林治疗,观察组患者在对照组基础上加用氯吡格雷治疗;两组患者均连续治疗2周。比较两组患者临床疗效、治疗前后血液流变学指标[全血低切黏度、血浆黏度、花生四烯酸(AA)诱导的血小板最大聚集率(MARAA)、二磷酸腺苷(ADP)诱导的血小板最大聚集率(MARADP)]、美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数(BI)评分,并观察两组患者治疗期间不良反应发生情况。结果观察组患者临床疗效优于对照组(P<0.05)。治疗前两组患者全血低切黏度、血浆黏度、MARAA、MARADP比较,差异无统计学意义(P>0.05);治疗后观察组患者全血低切黏度、血浆黏度、MARAA、MARADP低于对照组(P<0.05)。治疗前两组患者NIHSS评分、BI评分比较,差异无统计学意义(P>0.05);治疗后观察组患者NIHSS评分低于对照组,BI评分高于对照组(P<0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论阿司匹林联合氯吡格雷治疗急性脑梗死并脑微出血的临床疗效确切,可有效改善患者神经功能,提高患者生活质量,且安全性较高。

Objective To observe the clinical effect of aspirin combined with clopidogrel in treating acute cerebral infarction patients complicated with cerebral microbleeds. Methods A total of 76 acute cerebral infarction patients complicated with cerebral microbleeds were selected in Xianyang Hospital of Yan'an University from May 2015 to May 2016,and they were divided into control group and observation group according to random number table, each of 38 cases. Based on conventional treatment,patients of control group received aspirin, while patients of observation group received aspirin combined with clopidogrel; both groups continuously treated for 2 weeks. Clinical effect,index of hemorheology(including whole blood low-shear viscosity,plasma viscosity,arachidonic acid-induced maximum platelet aggregation rate and ADP-induced maximum platelet aggregation rate),NIHSS score and Barthel index before and after treatment were compared between the two groups,and incidence of adverse reactions was observed during the treatment. Results Clinical effect of observation group was statistically significantly better than that of control group(P < 0. 05). No statistically significant differences of whole blood low-shear viscosity,plasma viscosity,arachidonic acid-induced maximum platelet aggregation rate or ADP-induced maximum platelet aggregation rate was found between the two groups before treatment(P > 0. 05),while whole blood low-shear viscosity,plasma viscosity,arachidonic acid-induced maximum platelet aggregation rate and ADP-induced maximum platelet aggregation rate of observation group were statistically significantly lower than those of control group after treatment(P < 0. 05). No statistically significant differences of NIHSS score or Barthel index was found between the two groups before treatment(P > 0. 05); after treatmet,NIHSS score of observation group was statistically significantly lower than that of control group,while Barthel index of observation group was statistically significantly higher than that of control group(P < 0. 05). No statistically significant differences of incidence of adverse reactions was found between the two groups during the treatment(P > 0. 05). Conclusion Aspirin combined with clopidogrel has certain clinical effect in treating acute cerebral infarction patients complicated with cerebral microbleeds,can effectively improve the neurological function and quality of life,with relatively high safety.