阿司匹林联合氯吡格雷对恶化性脑梗死病人血流流变学及颅内血流动力学影响研究

Effect of the aspirin combined with clopidogrel on the blood rheology and intracranial hemodynamics in patients with worsening cerebral infarction

目的:研究阿司匹林联合氯吡格雷对恶化性脑梗死病人学血流流变学及颅内动力学的影响。方法:将92例恶化性脑梗死病人随机分为联合组及对照组,每组46例。联合组病人在常规治疗方案基础上加用阿司匹林及氯吡格雷。对照组在常规治疗方案基础上仅加用阿司匹林,治疗2个疗程。结果:治疗前,2组病人的血液流变学指标和脑中动脉(middle cerebral artery,MCA)、大脑前动脉(anterior cerebral artery,ACA)、大脑后动脉(posterior cerebral artery,PCA)平均流速及血栓弹力图和美国国立卫生研究院卒中量表(National Institutes Health Stroke scale,NIHSS)评分差异均无统计学意义(P>0.05),但2组间全血黏度高切差异有统计学意义(P<0.01)。治疗后,2组病人全血黏度、血浆黏度、红细胞比容、纤维蛋白原、MCA、ACA及PCA降低(P<0.05~P<0.01),联合组的全血黏度、血浆黏度、红细胞比容、MCA、ACA、PCA、M、Ma、α角、NIHSS分低于对照组(P<0.05),联合组的凝血启动至血凝块形成之间的潜伏期时间高于对照组(P<0.05),联合组的脑DSA显示动脉狭窄已明显缓解。对照组全血黏度低切差异无统计学意义(P>0.05),2组间纤维蛋白原差异无统计学意义(P>0.05)。2组病人不良反应均较轻,未出现颅内出血或消化系统出血(P>0.05)。结论:氯吡格雷与阿司匹林联合使用治疗恶化性脑梗死病人,有助于提高血液流动性,降低血栓形成风险及防止颅内动脉进一步狭窄堵塞,改善恶化性脑梗死病人神经功能。

Objective:To explore the effects of aspirin combined with clopidogrel on the blood rheology and intracranial hemodynamics in patients with worsening cerebral infarction(WCI).Methods:Ninety-two patients with WCI were divided into the combination group(n=46)and control group(n=46).The control group was treated with the conventional treatment combined with aspirin,and the combination group was treated with conventional treatment combined with aspirin and clopidogrel for two courses.Results:Before treatment,the differences of the blood rheology indicators,middle cerebral artery(MCA),anterior cerebral artery(ACA)and posterior cerebral artery(PCA),thromboelastography and National Institutes Health Stroke scale(NIHSS)score between two groups were not statistically significant(P>0.05),but the difference of whole blood viscosity between two groups was statistically significant(P<0.01).After treatment,the whole blood viscosity,plasma viscosity,hematocrit,fibrinogen,MCA,ACA and PCA significantly decreased in two groups(P<0.05),the whole blood viscosity,plasma viscosity,hematocrit,MCA,The ACA,PCA,M,Ma,αangle and NIHSS score in combination group were lower than those in control group(P<0.05).The latency time between the initiation of coagulation and formation of blood clot in combined group was higher than that in control group(P<0.05),and the results of DSA showed that the arterial stenosis in the combination group had been significantly alleviated.There was no statistical significance in total blood viscosity and fibrinogen between two groups(P>0.05).The adverse reactions in two groups were mild,no intracranial hemorrhage or gastrointestinal bleeding were found(P>0.05).Conclusions:Clopidogrel combined with aspirin in the treatment of WCI is helpful to improve the blood flow,reduce the risk of thrombosis,further prevent the stenosis of intracranial artery congestion,and improve the neural function of patients.