氯吡格雷联合阿司匹林治疗脑梗死合并高血压的临床疗效观察

Clinical efficacy of clopidogrel combined with aspirin in the treatment of cerebral infarction complicated with hypertension

目的探讨氯吡格雷联合阿司匹林治疗脑梗死合并高血压的临床疗效。方法102例脑梗死合并高血压患者,随机分为对照组和观察组,每组51例。两组均给予常规降压、降脂、改善脑循环、营养脑神经等治疗,在此基础上,对照组使用阿司匹林治疗,观察组在对照组基础上使用氯吡格雷治疗。比较两组临床疗效,治疗前后血液流变学指标、凝血指标及炎症指标、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数量表(BI)评分,不良反应发生率。结果观察组治疗总有效率94.12%高于对照组的76.47%,差异有统计学意义(P<0.05)。治疗后,观察组血浆粘度(1.70±0.15)mPa·s、全血低切粘度(12.95±1.28)mPa·s、血小板聚集率(41.76±7.67)%明显低于对照组的(1.91±0.29)mPa·s、(15.68±1.43)mPa·s、(59.84±8.72)%,最大血小板聚集时间(280.15±65.68)s明显长于对照组的(228.76±46.57)s,差异有统计学意义(P<0.05)。治疗后,观察组纤维原蛋白(FIB)(2.17±0.41)g/L、D-二聚体(D-D)(0.28±0.08)mg/L、凝血因子ⅩⅢ(FⅩⅢ)(75.46±9.27)%、C反应蛋白(CRP)(3.35±0.68)mg/L、肿瘤坏死因子-α(TNF-α)(1.42±0.60)ng/ml明显低于对照组的(2.86±0.58)g/L、(0.57±0.12)mg/L、(87.64±10.32)%、(5.76±1.07)mg/L、(1.76±0.37)ng/ml,差异有统计学意义(P<0.05)。治疗后,观察组NIHSS评分(11.87±3.31)分低于对照组的(18.46±4.28)分,BI评分(76.75±7.08)分高于对照组的(62.28±8.34)分,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论氯吡格雷联合阿司匹林治疗脑梗死合并高血压的临床疗效显著,能有效降低血液粘稠度,抑制血小板聚集及血栓形成,减轻炎症反应,改善神经功能缺损程度,提高生活质量。

Objective To discuss the clinical efficacy of clopidogrel combined with aspirin in the treatment of cerebral infarction complicated with hypertension.Methods A total of 102 patients with cerebral infarction and hypertension were randomly divided into control group and observation group,with 51 cases in each group.Both groups were given conventional antihypertensive,lipid-lowering,cerebral circulation improvement and cerebral nerve nutrition treatments.On this basis,the control group was treated with aspirin,and the observation group was treated with clopidogrel.Both groups were compared in terms of clinical efficacy,hemorheology index,coagulation index,inflammation index,National Institutes of Health Stroke Scale(NIHSS)score and Barthel index(BI)score before and after treatment,and the incidence of adverse reactions.Results The total effective rate of treatment in the observation group was 94.12%,which was higher than that of 76.47%in the control group,and the difference was statistically significant(P<0.05).After treatment,the observation group had plasma viscosity of(1.70±0.15)mPa·s,whole blood low-shear viscosity of(12.95±1.28)mPa·s and platelet aggregation rate of(41.76±7.67)%,which were significantly lower than those of(1.91±0.29)mPa·s,(15.68±1.43)mPa·s and(59.84±8.72)%in the control group;the maximum platelet aggregation time of(280.15±65.68)s in the observation group was significantly longer than that of(228.76±46.57)s in the control group;the differences were statistically significant(P<0.05).After treatment,the observation group had fibrinogen(FIB)of(2.17±0.41)g/L,D-dimer(D-D)of(0.28±0.08)mg/L,coagulation factorⅩⅢ(FⅩⅢ)of(75.46±9.27)%,C-reactive protein(CRP)of(3.35±0.68)mg/L,and tumor necrosis factor-α(TNF-α)of(1.42±0.60)ng/ml,which were significantly lower than those of(2.86±0.58)g/L,(0.57±0.12)mg/L,(87.64±10.32)%,(5.76±1.07)mg/L,and(1.76±0.37)ng/ml in the control group,and the differences were statistically significant(P<0.05).After treatment,NIHSS score of(11.87±3.31)points in the observation group was lower than that of(18.46±4.28)points in the control group,and BI score of(76.75±7.08)points was higher than that of(62.28±8.34)points in the control group.The differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Clopidogrel combined with aspirin in the treatment of cerebral infarction complicated with hypertension has significant clinical efficacy,which can effectively reduce blood viscosity,inhibit platelet aggregation and thrombosis,reduce inflammation,improve the degree of neurological deficit,and improve the quality of life.