不同剂量阿司匹林对急性脑梗死患者rt-PA溶栓治疗后出血转化的影响

Effect of different doses of aspirin on hemorrhagic transformation in patients with acute cerebral infarction after rt-PA thrombolytic therapy

目的探讨不同剂量阿司匹林对急性脑梗死(ACI)患者重组人组织型纤维蛋白溶酶原激活物(rt-PA)溶栓治疗后出血性转化(HT)的影响。方法选取2014年8月-2017年8月收治的ACI患者60例作为研究对象,均于4.5h内进行rt-PA溶栓治疗,溶栓24h后使用阿司匹林,根据阿司匹林给药剂量分为低剂量组(150mg·d^(-1),32例)和高剂量组(300mg·d^(-1),28例),采用NIHSS评分评估2组患者溶栓前和溶栓24h、7d、14d神经功能缺损程度,采用改良Rankin量表评估患者90d预后,统计2组治疗期间HT及其他出血并发症发生率。结果 2组溶栓24h、7d、14d NIHSS评分均较溶栓前下降(P<0.05);2组溶栓24h、7d、14d NIHSS评分比较无差异(P>0.05);低剂量组HT发生率为6.25%与高剂量组的10.71%比较无差异(P>0.05);低剂量组出血并发症发生率为12.50%,低于高剂量组的35.71%(P<0.05);2组患者90d预后比较无差异(P>0.05)。结论 ACI患者rt-PA溶栓24h后分别给予150mg·d^(-1)、300mg·d^(-1)阿司匹林对其神经功能改善、近期预后及HT发生率无影响,但高剂量阿司匹林会增加其他出血并发症发生风险。

Objective To investigate the effect of different doses of aspirin on hemorrhagic transformation （HT） in patients with acute cerebral infarction （ACI） after recombinant human tissue plasminogen activator （rt-PA） thrombolytic therapy. Method60 patients with ACI who were admitted during the period from August 2014 to August 2017 were selected as the subjects. All patients were given rt-PA thrombolytic therapy within 4.5h, and aspirin was used after 24h of thrombolytic therapy. According to the dose of aspirin, the patients were divided into low dose group （150mg·d^-1, 32 cases） and high dose group （300mg·d^-1, 28 cases）. The neurological impairment in the 2 groups was evaluated with the NIHSS score before treatment and after 24h, 7d and 14d of treatment. The 90d prognosis was evaluated with modified Rankin scale. The incidence rates of HT and other bleeding complications in the two groups during the treatment were statistically analyzed. Results After 24h, 7d and 14d of thrombolytic therapy, NIHSS scores in the two groups were decreased （P〈0.05）, without significant difference between the two groups （P〉0.05）.There was no significant difference in the incidence of HT between the two groups （6.25% vs 10.71%） （P〉0.05）. The incidence of other bleeding complications in the low dose group was lower than that in the high dose group （12.50% vs 35.71%） （P〈0.05）. There was no significant difference in the 90d prognosis between the two groups （P〉0.05）. ConclusionUsing 150mg·d^-1 and 300mg·d^-1 of aspirin in 24h after rt-PA thrombolytic therapy has no effect on the improvement of neurological function, short-term prognosis and the incidence of HT. However, high dose aspirin will increase the risk of other bleeding complications.