阿司匹林与氯吡格雷治疗缺血性脑卒中患者的研究比较

Effect comparison between aspirin and clopidogrel for ischemic cerebral stroke patients

目的比较阿司匹林与氯吡格雷对缺血性脑卒中患者的疗效。方法选择120例缺血性脑卒中患者,分为阿司匹林组、氯吡格雷组和联合组各40例。阿司匹林组口服阿司匹林治疗,氯吡格雷组口服氯吡格雷治疗,联合组给予阿司匹林+氯吡格雷。比较2组治疗前后血小板聚集率、血液流变学、神经功能缺损评分(NIHSS)、日常生活能力评分(ADL)的变化和临床疗效,并随访半年,记录再发缺血性脑卒中率、出血率及死亡率。结果治疗后,3组血小板聚集率、全血黏度、血浆黏度、纤维蛋白原较治疗前均显著降低(P<0.05);阿司匹林组和氯吡格雷组血小板聚集率、全血黏度、血浆黏度、纤维蛋白原比较无显著差异(P>0.05),联合组血小板聚集率、全血黏度、血浆黏度、纤维蛋白原明显低于阿司匹林组、氯吡格雷组(P<0.05);治疗后,3组NIHSS评分、ADL评分较治疗前均显著改善(P<0.05),阿司匹林组和氯吡格雷组NIHSS评分、ADL评分比较无显著差异(P>0.05),联合组NIHSS评分显著低于阿司匹林组、氯吡格雷组,ADL评分显著高于阿司匹林组、氯吡格雷组(P<0.05);联合组临床疗效总有效率为95.00%,显著高于阿司匹林组、氯吡格雷组的70.00%、75.00%(P<0.05);在随访过程中显示,3组出血、死亡发生率比较无显著差异(P>0.05),氯吡格雷组、联合组再发缺血性脑卒中率为5.00%、2.50%,均显著低于阿司匹林组的25.00%(P<0.05)。结论在缺血性脑卒中患者中应用阿司匹林联合氯吡格雷效果显著,有助于促进神经功能恢复,提高预后,临床用药价值高。

Objective To compare the effect of aspirin and clopidogrel for ischemic cerebral stroke patients. Methods A total of 120 patients with ischemic cerebral stroke in our hospital were selected,and were divided into aspirin group,clopidogrel group and combined treatment group according to different medication methods,with 40 cases per group. The aspirin group received oral administration of aspirin,the clopidogrel group received clopidogrel,and the combined treatment group was given aspirin and clopidogrel treatment in combination. The changes of platelet aggregation rate,hemorheology,neurological impairment score（ NIHSS） and daily living ability score（ ADL） were compared between two groups before and after treatment,and the recurrent rate of ischemic stroke,bleeding rate,and mortality rate were recorded after half a year follow up. Results After treatment,the platelet aggregation rate,whole blood viscosity,plasma viscosity and fibrinogen in the three groups were significantly lower than treatment before（ P〈0. 05）; platelet aggregation rate,whole blood viscosity,plasma viscosity and fibrinogen between aspirin group and clopidogrel group showed no significant difference（ P〈0. 05）; but were significantly lower in the combined treatment group than that of the aspirin group and clopidogrel group（ P〈0. 05）. After treatment,the NIHSS score and ADL score of the three groups were significantly improved compared with treatment before（ P〉0. 05）,but there was no significant difference in NIHSS score and ADL score between aspirin group and clopidogrel group（ P〈0. 05）; and the combined treatment group had significantly lower NIHSS score,and significantly higher ADL score than the aspirin group and clopidogrel group（ P〈0. 05）. The total clinical outcome in the combined treatment group was 95. 00%,which was significantly higher than 70. 00%,75. 00%,respectively,in the aspirin group and clopidogrel group（ P〈0. 05）. During follow-up,there was no significant difference in the bleeding rate and mortality rate between the three groups（ P〈0. 05）. The recurrent rate of ischemic stroke rate in the clopidogrel group and the combined treatment group were 5. 00% and 2. 50%,respectively,which was significantly lower than 25. 00% of the aspirin group（ P〈0. 05）. Conclusion Aspirin combined with clopidogrel has remarked clinical efficacy in the treatment of ischemic cerebral stroke,and can promote recovery of neurological function and improve prognosis,so it is of high value in clinical application.