脑梗塞患者抗血小板聚集药物治疗血栓弹力图检测分析

Analysis of Thrombelastogram in Patients with Cerebral Infarction Treated with Antiplatelet Drugs

目的探讨在脑梗塞,特别是急性脑梗死治疗中,血栓弹力图(TEG)对抗血小板聚集药物(阿司匹林、氯吡格雷)单用和联合应用的达标率的监测作用。方法回顾分析武汉市中西医结合医院2014年5月—2016年12月期间脑梗塞患者单用阿司匹林、氯吡格雷及联合运用行抗血小板聚集治疗的TEG结果,结合相关文献资料进行分析。结果 195例单用阿司匹林抗血小板聚集治疗中,TEG显示阿司匹林组未达标率26.15%(51/195),其中急性脑梗死患者未达标率27.13%(35/129),急性非脑梗死患者未达标率24.24%(16/66),差异无统计学意义(P>0.05)。氯吡格雷组未达标率26.51%(22/83),其中急性脑梗死患者未达标率28.00%(14/50),急性非脑梗死患者未达标率24.24%(8/33),差异无统计学意义(P>0.05)。488例双抗患者中,阿司匹林未达标者103例(21.11%),氯吡格雷未达标者74例(15.16%),二者均未达标者31例(6.35%),其中急性脑梗死患者中阿司匹林未达标率23.40%(84/359),氯吡格雷未达标率18.94%(68/359),二者均未达标率8.08%(29/359)。结论脑梗塞患者,特别是急性脑梗死患者的抗血小板聚集治疗,应对患者行整体评估后,再结合TEG检测结果,采取不同的抗血小板聚集药物治疗方案。

Objective To investigate the monitoring effect of Thrombelastogram （TEG） on the compliance rate of platelet aggregation drugs （Aspirin and Clopidogrel） alone and in combina- tion in the treatment of cerebral infarction, especially acute cerebral infarction, so as to guide the clinical medication.Methods The results of TEG of anti-platelet aggregation therapy with As- pirin and Clopidogrel alone and combined anti-platelet aggregation in patients with cerebral in- farction from May 2014 to December 2016 in Wuhan Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively analyzed and summarized, and the related literature data were analyzed.Results Among 195 patients treated with aspirin alone, it showed that 51 ca- ses of Thrombelastogram failed to meet the standard.The failure rate was 26. 15%（51/195）.A- mong 129 cases of acute cerebral infarction,35 cases failed to meet the standard,and the rate was 27.13%.Among 66 cute non-infarction patients,51 cases failed to meet the standard,andthe rate was 24.24%.The difference was not statistically significant （P〉0.05）.Among 83 pa- tients treated with Clopidogrel,22 cases failed to meet the standard.The failure rate was 26.51% （22/83） .Among 50 cases of acute cerebral infarction, ]4 cases failed to meet the standard,and the rate was 28.00%.Among 33 cute non-infarction patients,8 cases failed to meet the stand- ard,and the rate was 24.24%.The difference was not statistically significant （P〉0.O5）.Among 488 double-antibody patients, ]03（2].]1%） cases did not meet the standard of Aspirin and 74 （]5.]6%） cases failed to meet the standard of Clopidogrel.31（6.35%） cases failed to meet the standard of Aspirin and ClopidogreI.Among 359 cases of acute cerebral infarction,84 （23.40%） cases did not meet the standard of Aspirin and 68 （18.94%） cases failed to meet the standard of CIopidogrel.29（8.08%） cases failed to meet the standard of Aspirin and ClopidogreI.Cenclu- sion For patients with cerebral infarction patients and anti-platelet aggregation therapy,the o- verall assessment should be carried out and combined with Thrombelastogram test to take a different anti-platelet aggregation drug treatment program.It is more likely to produce drug re- sistance.