心房纤颤合并脑梗死急性期阿司匹林和氯吡格雷治疗的比较

Comparison the efficacy of aspirin and clopidogrel about atrial fibrillation with acute cerebral infarction

目的 比较心房纤颤合并脑梗死患者急性期阿司匹林和氯吡格雷治疗的有效性和安全性.方法 连续收集2011年1月至2014年6月入住同济大学附属东方医院神经内科脑卒中中心的心房纤颤合并急性脑梗死患者为研究对象.采取住院号单双数的随机化原则分入阿司匹林治疗组或氯吡格雷治疗组.阿司匹林治疗组给予阿司匹林片,0.1g·次-1·d-1,口服或鼻饲.氯吡格雷组给予氯吡格雷片, 75 mg·次-1·d-1,口服或鼻饲.其他治疗原则按照美国心脏协会(American Heart Association,AHA)/美国卒中协会(American Stroke Association,ASA)成人缺血性卒中早期处理指南予以处理.分别在入院时和治疗后21d对两组患者进行美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评分和改良的Rankin量表(modiifed Rankin Scale,mRS)评分.同时比较两组的所有出血、颅内出血、症状性颅内出血、消化道出血、脑梗死再发、深静脉血栓发生率;比较两组病死率;比较两组的住院天数及治疗总费用、药物费用、药占比.计数资料应用卡方检验或Fisher精确概率法检验;符合正态分布的计量资料应用t检验;不符合正态分布的计量资料应用秩和检验.结果两组患者21d NIHSS评分较入院时均有改善,阿司匹林组0~21(4)比0~15(3)(z=-4.826,P=0.000),氯吡格雷组0~15(7)比0~14(3)(z=-3.086,P=0.002),差异具有统计学意义;两组患者21d mRS评分较入院时也均有改善,阿司匹林组0~5(3)比0~6(2)(z=-3.240,P=0.001),氯吡格雷组0~5(4)比0~6(2)(z=-2.547,P=0.011),差异具有统计学意义.两组之间的21d NIHSS评分、mRS评分差异无统计学意义(P>0.05).两组患者病死率差异无统计学意义(P>0.05).两组患者出血发生率、颅内出血发生率、症状性颅内出血发生率、消化道出血发生率差异均无统计学意义(P>0.05);两组脑梗死再发率、DVT发生率差异均无统计学意义(P>0.05).两组住院天数差异无统计学意义(P>0.05);两组住院总费用、药物费用及药占比差异均无统计学意义(P>0.05).结论 心房纤颤合并脑梗死患者急性期阿司匹林治疗和氯吡格雷治疗的有效性和安全性相似.

Objective Comparing the efficacy and safety about aspirin and clopidogrel therapy for atrial fibrillation with cerebral infarction in acute phase.Methods Continuously collected the patients of acute cerebral infarction with atrial fibrillation in the department of neurology in East Hospital affiliated to Tongji University in January 2011 to June 2014.The patients were divided into aspirin or clopidogrel therapy group taking the principle of random.Aspirin group was given aspirin tablets 0.1g through oral or nasal,qd.Clopidogrel group was given clopidogrel tablets 75 mg through oral or nasal,qd.Other therapy was dealt in accordance with the American Heart Association(AHA) /(American Stroke Association)ASA adult ischemic stroke early treatment guidelines.Scoring the two groups respectively at the time of admission and after treatment of patients using National Institute of Health Stroke Scale(NIHSS)and modified Rankin Scale(m RS) after 21 days.At the same time,incidence rates of these two groups were compared,such as bleeding,intracranial hemorrhage,symptomatic intracranial hemorrhage,gastrointestinal bleeding,recurrent infarction,deep vein thrombosis; comparing the mortality of them; at last,Comparison was taken between the two groups including hospital stay and the total cost of treatment,drug costs and the percentage of drug.Results NIHSS and m RS score of these two groups both improved compared with base line in 21 days,the difference was statistically significant(P<0.05),while the difference of two groups was no statistically significant(P>0.05).The incidence of cerebral infarction recurrence and DVT between two groups was none of significant difference(P> 0.05).Two groups of hospital stay was none of significant difference(P> 0.05); The differences about the total cost of the two groups about hospitalization,drug costs and the percentage of drug was not statistically significant(P> 0.05).Conclusions The efficacy and safety about aspirin and Clopidogrel therapy for patients of acute cerebral infarction with atrial fibrillation was similar.