阿司匹林联合氯吡格雷与低相对分子质量肝素治疗进展性脑梗死

Aspirin plus Clopidogrel and Low Molecular Weight Heparin in the Treatment of Progressive Cerebral Infarction

目的探索阿司匹林联合氯比格雷与低相对分子质量肝素(LMWH)治疗进展性脑梗死(PCI)的疗效并评估出血风险。方法将148例PCI患者随机分为对照组和治疗组,每组74例患者。对照组患者口服阿司匹林100mg/次,每日一次;氯比格雷75 mg/次,每日一次;治疗组在服用阿司匹林和氯吡格雷的基础上皮下注射LMWH钠5 000U,每日两次;连续治疗2周。在治疗前14 d和治疗后14 d分别对两组患者的神经功能缺损评分(NDS)、凝血酶时间(TT)﹑血小板(PLT)﹑凝血酶原时间(PT)、活化部分凝血活酶时间(a PTT)以及纤维蛋白原(Fbg)等凝血功能指标进行评定,并且统计出血情况,包括颅内出血、牙龈出血、上下消化道出血、皮下严重出血等出血情况。结果治疗后,治疗组和对照组的NDS均降低,并且治疗组的NDS评分明显低于对照组(P<0.05),治疗组的总体有效率也高于对照组;而对照组与治疗组患者在治疗前后的凝血功能指标未发生显著性改变,并且在治疗过程中两组患者的出血发生率无显著性差异(P>0.05)。结论阿司匹林联合氯吡格雷及LMWH三联用药治疗PCI比阿司匹林合用氯吡格雷二联用药疗效更显著,而且并不增加出血风险。

Objective To explore the combination of aspirin and clopidogrel and low molecular weight heparin（ LMWH） in treatment of progressive cerebral infarction（ PCI） the curative effect and to assess the risk of bleeding. Methods 148 patients with PCI were randomly divided into control group and treatment group,74 patients in each group. The control group were treated with aspirin 100 mg/,once daily; clopidogrel 75 mg/times,once a day; the treatment group subcutaneous LMWH sodium injection 5 000 U on the basis of taking aspirin and clopidogrel,two times daily for 2 weeks. Before treatment,14 days and 14 days after treatment respectively in two groups of patients with neurological deficit score（ neural function,deficient scale,NDS）,thrombin time（ TT）,bleed platelet count（ BPC）,prothrombin time（ PT）,activated partial thromboplastin time（ a PTT）,and fibrinogen（ Fbg） and blood coagulation indexes were evaluated,and the statistical bleeding,including intracranial hemorrhage,bleeding gums,upper and lower gastrointestinal bleeding,subcutaneous bleeding and other serious bleeding. Results After treatment,the treatment group and the control group the decrease of NDS significantly lower and treatment group was than the control group（ P〈0. 05）,the over all efficiency of the treatment group is higher than that of the control group; the control group and the treatment group in patients with blood coagulation indexes before and after treatment was no significant change,bleeding of the two groups of patients the incidence rate had no significant difference（ P〉0. 05）. Conclusion Aspirin combined with clopidogrel and LMWH triple therapy is more effective than aspirin and clopidogrel two in the treatment of PCI,and does not significantly increase the risk of bleeding.