阿司匹林对重症脑血管病早期发生急性呼吸窘迫综合征的影响

The Influence of Aspirin on Early Development of Acute Respiratory Distress Syndrome in Severe Cerebrovascular Disease

目的探讨服用阿司匹林对重症脑血管病早期急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)发生率的影响。方法该研究为前瞻性队列研究,连续纳入收住首都医科大学附属北京天坛医院脑血管病中心神经重症监护室(neurologic intensive care unit,NICU)的急性重症脑血管病[发病48 h内格拉斯哥昏迷评分(Glasgow coma scale,GCS)≤8分]的309例患者,登记患者的性别、年龄、既往病史、卒中前服药史、基线GCS评分、原发病、是否进行全身麻醉及开颅手术、是否早期发生ARDS以及机械通气时间、NICU住院时间、死亡率等。按照患者发病前是否规律服用阿司匹林分为阿司匹林组和非阿司匹林组,对比两组患者早期ARDS发生率。同时对发生ARDS的患者与非ARDS患者两组的临床因素进行比较。结果阿司匹林组(106例)较非阿司匹林组(203例)的ARDS发生率(20.8%vs 30.5%,P=0.045)显著减低,阿司匹林组患者的平均年龄较大[(62.41±10.69)岁vs(57.40±14.80)岁,P=0.002]、合并高血压(50.9%vs 38.4%,P=0.035)、冠状动脉粥样硬化性心脏病(31.1%vs 20.2%,P=0.032)、同时服用他汀类药物的比例(26.4%vs 8.4%,P=0.002)也较高,原发病构成比例中缺血性卒中的比例更高。ARDS组(86例)与非ARDS(223例)组比较,患者入院时GCS评分[(3.87±1.61)vs(6.48±1.51),P=0.043]较低、机械通气时间[6(5~8)d vs 0(0~3)d,P=0.001]和NICU住院时间[8(6~10)d vs 3(2~4)d,P=0.001]较长,但死亡率无显著差异。结论发病前规律服用阿司匹林能够减少重症脑血管病患者早期ARDS的发生率,但不能降低机械通气时间、NICU住院时间及死亡率。

Objective To investigate the influence of Aspirin on the early development of acute respiratory distress syndrome （ARDS） incidence rate in patients with severe cerebrovascular disease. Methods This was a prospective cohort study. A total of 309 patients admitted to the neurologic intensive care unit （NICU） of our hospital within 48 hours after onset of severe cerebrovascular disease with a Glasgow Coma Scale （GCS） score ≤8 points were consecutively enrolled. Subjects of entry included sex, age, medical history, medication preceding onset, baseline score of GCS, primary disease, whether the patient underwent anesthesia and/or received craniotomy, early ARDS occurrence, mechanical ventilation time, length of stay in NICU, mortality rate, etc. The ARDS incidence rates of two groups were compared. Meanwhile, the clinical factors of patients of ARDS and non-ARDS groups were compared. Results There was a significant reduction of ARDS incidence rate in aspirin group （n=106） as opposed to non-aspirin group （n=203） 20.8% vs 30.5% （P=0.045）. Patients of the aspirin group had a higher average age[（62.41±10.69） vs （57.40±14.80）, P=0.002], a larger percentage of combined hypertension （50.9% vs 38.4%, P=0.035）, more coronary heart disease （31.1% vs 20.2%, P=0.032）, and higher rate of taking statins （26.4% vs 8.4%, P=0.002）. Ischemic stroke accounted for a larger proportion of the primary disease in this group. As opposed to non-ARDS group （223 cases）, ARDS group （n=86） had lower GCS scores [（3.87±1.61） vs （6.48±1.51）, P=0.043], less mechanical ventilation time [6 （5-8）d vs 0 （0-3）d, P=0.001], and required longer NICU stay [8 （6-10）d vs 3 （2-4）d, P=0.001], but had no significant difference in mortality rate. Conclusion Regular use of aspirin can reduce early ARDS incidence rate in severe cerebrovascular diseases, but cannot reduce mechanical ventilation time, duration of stay in NICU or morality rate.