阿替普酶静脉溶栓前应用抗血小板药物对急性脑梗死患者疗效的影响

Effect of antiplatelet drugs before intravenous thrombolytic therapy with alteplase on patients with acute cerebral infarction

目的探讨急性缺血性脑卒中患者发病前应用抗血小板药物对其静脉溶栓疗效的影响。方法 选取201412—201611漯河市中心医院收治的急性缺血性脑卒中患者126例,依据发病前是否采用抗血小板药物治疗分为观察组(发病前应用抗血小板药物治疗)和对照组(未应用抗血小板药物),2组均采用静脉溶栓治疗,观察分析其神经功能恢复及并发症发生情况。结果 2组脑卒中预后、病死率、颅内出血发生率等均无明显差异(P>0.05);溶栓前NIHSS评分、早期缺血改变均是影响患者溶栓后发生症状性颅内出血的高危因素(P<0.05),发病前应用抗血小板药物不会导致溶栓后症状性颅内出血风险上升(P>0.05);溶栓前NIHSS评分、症状性颅内出血、溶栓前早期缺血改变、溶栓前收缩压及血糖均会对患者静脉溶栓预后造成影响,而发病前应用抗血小板药物与预后无明显相关性(P>0.05)。结论 发病前应用抗血小板药物不会对急性缺血性脑卒中患者静脉溶栓预后造成明显影响,且不会引起溶栓后症状性颅内出血等并发症的发生风险上升,是一种较为安全、有效的治疗策略。

Objective To investigate the effect of antiplatelet drugs on the efficacy of intravenous thrombolysis in patients with acute ischemic stroke before onset. Methods A total of 126 patients with acute ischemic stroke admitted to the Central Hospital of Luohe from December 2014 to November 2016 were enrolled.The patients were divided into observation group (antiplatelet therapy before onset) and control group according to whether antiplatelet drugs were used before onset.(Antiplatelet drugs were not used),and both groups were treated with intravenous thrombolysis.The recovery of neurological function and complications were observed and analyzed. Results There were no significant differences in the prognosis,mortality,and incidence of intracranial hemorrhage between the two groups ( P >0.05).The NIHSS score and early ischemic changes before thrombolysis were risk factors for symptomatic intracranial hemorrhage after thrombolysis( P <0.05),the application of antiplatelet drugs before onset did not lead to an increased risk of symptomatic intracranial hemorrhage after thrombolysis ( P >0.05);NIHSS score before thrombolysis,symptomatic intracranial hemorrhage,early ischemic changes before thrombolysis,dissolution Pre plug systolic blood pressure and blood glucose all have an effect on the prognosis of patients with intravenous thrombolysis,and there is no significant correlation between the application of anti platelet drugs and the prognosis before the onset ( P >0.05). Conclusion The application of anti platelet drugs before onset will not have a significant impact on the prognosis of intravenous thrombolysis in patients with acute ischemic stroke,and it will not cause the risk of complications such as symptomatic intracranial hemorrhage after thrombolysis.It is safer.Effective treatment strategy.