达比加群酯联合丁苯酞治疗轻型缺血性脑卒中/短暂性脑缺血发作患者的临床效果评价

Clinical effects of dabigatran combined with butylphthalide in the treatment of patients with minor ischemic stroke or transient ischemic attack

目的观察达比加群酯联合丁苯酞治疗轻型缺血性脑卒中/短暂性脑缺血发作(MIS/TIA)患者的临床效果。方法将123例MIS/TIA患者随机分为对照组(单用达比加群酯)和联合治疗组(达比加群酯联合丁苯酞),比较两组患者治疗前后NIHSS评分、Barthel指数(BI指数)及改良Rankin量表(mRS)评分,并统计两组患者90 d内颅内出血率、消化道出血率、90 d复发率及病死率。结果两组患者治疗前NIHSS、BI及mRS评分比较,差异均无统计学意义(P>0.05);治疗后,与对照组相比,联合治疗组的BI评分显著升高,NIHSS及mRS评分则显著降低,且差异具有统计学意义(P<0.05)。联合治疗组临床总有效率为88.52%,显著高于对照组(66.52%),差异具有统计学意义(P<0.05)。两组患者均未发生症状性颅内出血,联合治疗组有1例消化道出血,出血发生率为1.64%,对照组有3例消化道出血,出血发生率为4.84%。两组出血发生率相比,差异无统计学意义(P>0.05)。两组均未出现死亡病例。联合治疗组患者的90 d复发率明显低于对照组(P<0.05)。结论达比加群酯联合丁苯酞应用于MIS/TIA患者早期短程治疗中,临床效果较为显著,在不增加出血率的情况下,能够有效减少MIS/TIA的总复发率,且可促进患者神经功能恢复,提高日常生活活动能力。

Objective To investigate the clinical effects of dabigatran combined with butylphthalide in the treatment of patients with minor ischemic stroke or transient ischemic attack(MIS/TIA).Methods Totally 123 patients with MIS/TIA were randomly divided into control group(dabigatran axetil alone)and combined treatment group(dabigatran axetil combined with butylphthalide).Before and after treatment,the NIHSS score,barhel index(BI)and modified Rankin Scale(mRS)score of the two groups were compared.The intracranial hemorrhage rate,gastrointestinal bleeding rate,recurrence rate and mortality of the two groups within 90 days were statistically analyzed.Results There was no statistical difference in NIHSS,BI or mRS score between the two groups before treatment(P>0.05).The NIHSS score and the mRS score in combination treatment group were significantly lower than those in control group,and the BI score in combination treatment group was markedly higher than that in control group(P<0.05).The total clinical effective rate in combination treatment group was 88.52%,significantly higher than that of control group(66.52%)(P<0.05).There was no case of symptomatic cerebral hemorrhage or death in both groups after treatment.The rate of gastrointestinal hemorrhage was slightly lower in combination treatment group(one case,1.64%)when compared with that in control group(3 cases,4.84%),but there was no statistic difference.The 90-day recurrence rate in combination treatment group was significantly lower than that in control group(P<0.05).Conclusion The application of dabigatran combined with butylphthalide in the early and short-term treatment of patients with MIS/TIA has a significant clinical effect.Without increasing the bleeding rate,it can effectively reduce the total recurrence rate of MIS/TIA,promote the recovery of neurological function and improve the ability of daily living activities.