抗血小板预处理在轻度致残性脑梗死溶栓中的应用效果观察

Observation on the use of Antiplatelet preconditioning before thrombolysis in patients with mild disabling cerebral infarction

目的:探讨在致残性轻度脑梗死患者低剂量阿替普酶静脉溶栓前给予双联抗血小板(阿司匹林100 mg加氯吡格雷75 mg)进行预处理的安全性及有效性。方法:选取38例轻度致残性脑梗死患者,按照入院先后顺序分为对照组(n=22)与试验组(n=16)。对照组给予常规剂量(0.9 mg/kg)阿替普酶进行静脉溶栓治疗,24 h后进行头颅影像学检查除外出血后,常规加双联抗血小板治疗。试验组使用小剂量(0.6 mg/kg)阿替普酶进行静脉溶栓前半小时给予口服阿司匹林(100 mg)加氯吡格雷(75 mg)进行抗血小板治疗,再给予小剂量(0.6 mg/kg)阿替普酶进行静脉溶治疗。评估两组患者溶栓后24、72 h的神经功能情况(NIHSS评分),3个月的改良Rankin量表(mRS)评分,1周内的出血并发症发生率及早期症状加重率。结果:两组24、72 h的NIHSS评分明显低于入院时,差异有统计学意义(P<0.05);试验组入院时及24、72 h的NIHSS评分与对照组比较,差异无统计学意义(P>0.05)。试验组溶栓后的出血发生率为12.5%,与对照组的27.3%比较,差异无统计学意义(P>0.05)。试验组的早期症状加重发生率低于对照组,差异有统计学意义(P<0.05);两组3个月后mRS评分比较,差异无统计学意义(P>0.05)。结论:轻度致残性脑梗死患者使用阿替普酶静脉溶栓前给予双联抗血小板预处理与常规标准剂量阿替普酶溶栓效果无显著差异,但能降低早期症状加重发生率。

Objective To investigate the safety and efficacy of dual antiplatelet(aspirin 100 mg plus clopidogrel 75 mg)pretreatment before intravenous thrombolytic therapy with low-dose alteplase in patients with disabling and mild cerebral infarction.Methods A total of 38 patients with mild disabling acute cerebral infarction were selected as the study subjects and divided into the control group(22 cases)and the experimental group(16 cases)according to the order of admission.The control group received intravenous thrombolytic therapy with a conventional dose(0.9 mg/kg)of Alteplase,and 24 hours later,routine dual antiplatelet therapy was added after reexamination of the cranial imaging examination,except for bleeding.Before intravenous thrombolysis with low dose(0.6 mg/kg)of Alteplase,the experimental group was given routine aspirin(100 mg)and clopidogrel(75 mg)for antiplatelet therapy,and a low dose(0.6 mg/kg)of Alteplase for intravenous thrombolysis.The neurological function(NIHSS score),the modified Rankin scale(mRS)score at 3 months,the incidence of bleeding complications within 1 week,and the rate of early symptom exacerbation were evaluated in the two groups at 24 and 72 hours after thrombolysis.Results The NIHSS scores at 24 and 72 hours in the two groups were significantly lower than those at admission(P<0.05).There were no statistically significant differences in the NIHSS scores between the experimental group and the control group at admission,24,and 72 hours(P>0.05).The incidence of bleeding after thrombolysis in the experimental group was 12.5%,compared with 27.3%in the control group,with no statistically significant difference(P>0.05).The incidence of early symptom exacerbation in the experimental group was lower than that in the control group(P<0.05).There was no statistically significant difference in mRS scores between the two groups after 3 months(P>0.05).Conclusion Dual antiplatelet preconditioning before intravenous thrombolysis with Alteplase in patients with disabling and mild cerebral infarction is as effective as conventional standard dose Alteplase thrombolysis,and can reduce the incidence of early exacerbation of symptoms.