2020 年第 10 期 第 15 卷

抗血小板聚集预处理联合静脉溶栓治疗急性脑梗死的临床效果和安全性

Safety and efficacy of anti-platelet aggregation pretreatment and intravenous thrombolysis in the treatment of acute cerebral infarction

作者：孙炎孙健薛茜王小琴

英文作者：Sun Yan Sun Jian Xue Qian Wang Xiaoqin

单位：河北北方学院附属第一医院神经内科，河北省张家口市075000

英文单位：Department of Neurology the First Affiliated Hospital of Hebei North University Hebei Province Zhangjiakou 075000 China

关键词：急性脑梗死；抗血小板聚集预处理；静脉溶栓

英文关键词：Acutecerebralinfarction；Anti-plateletaggregationpretreatment;Intravenousthrombolysis

• 摘要：

• 目的 探讨抗血小板聚集预处理联合阿替普酶静脉溶栓治疗急性脑梗死的临床效果及其安全性。方法 选取2018年1月至2019年1月河北北方学院附属第一医院收治的急性脑梗死患者120例，应用随机数字表法分为4组，每组30例，常规溶栓组应用阿替普酶静脉溶栓前不口服抗血小板药物，阿司匹林组在静脉溶栓前1 h内口服阿司匹林进行预处理，氯吡格雷组在静脉溶栓前1 h内口服氯吡格雷进行预处理，联合治疗组在静脉溶栓前1 h内口服阿司匹林联合氯吡格雷进行预处理。比较4组患者溶栓前和溶栓后24 h和7、14 d的美国国立卫生研究院卒中量表（NIHSS）评分和用药90 d的总有效率以及治疗期间的不良反应发生率。结果 溶栓前4组患者NIHSS评分比较差异无统计学意义（P>0.05）。溶栓后24 h和溶栓后7、14 d，阿司匹林组、氯吡格雷组和联合治疗组NIHSS评分均低于常规溶栓组，且联合治疗组低于阿司匹林组和氯吡格雷组（均P<0.05），但阿司匹林组与氯吡格雷组比较差异均无统计学意义（均P>0.05）。治疗90 d后，阿司匹林组、氯吡格雷组和联合治疗组总有效率均高于常规溶栓组［70.0%(21/30)、66.7%(20/30)、96.7%(29/30)比53.3%（16/30）］，且联合治疗组高于阿司匹林组和氯吡格雷组（均P<0.05），但阿司匹林组与氯吡格雷组比较差异无统计学意义（P>0.05）。4组患者治疗期间不良反应发生率比较差异无统计学意义（P＞0.05）。结论 急性脑梗死患者在应用阿替普酶静脉溶栓前应用抗血小板聚集药物预处理可以增加静脉溶栓治疗效果，降低致残率。

• Objective To investigate the clinical effect and safety of anti-platelet aggregation pretreatment combined with alteplase intravenous thrombolysis in the treatment of acute cerebral infarction. Methods Totally 120 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Hebei North University from January 2018 to January 2019 were selected. They were randomly divided into 4 groups, with 30 cases in each group. The routine thrombolytic group did not take antiplatelet drugs before intravenous thrombolysis. Aspirin group was pretreated with oral aspirin within 1 h before intravenous thrombolysis.Clopidogrel group was pretreated with oral clopidogrel within 1 h before intravenous thrombolysis. The combined treatment group was pretreated with oral aspirin and clopidogrel within 1 h before intravenous thrombolysis. The National Institutes of Health Stroke Scale (NIHSS) scores before and 24 h, 7 d and 14 d after thrombolysis， total effective rate after 90 d of medication and the incidence of adverse reactions during treatment were compared among the four groups. Results There was no significant difference in NHISS scores among the four groups before thrombolysis (P>0.05). At 24 h and 7, 14 d after thrombolysis, NIHSS scores of aspirin group, clopidogrel group and combined treatment group were lower than those of routine thrombolysis group, and the combined treatment group was lower than that of aspirin group and clopidogrel group (all P<0.05), but there were no significant differences between aspirin group and clopidogrel group (all P>0.05). After 90 d of treatment, the total effective rates of aspirin group, clopidogrel group and combined treatment group were higher than that of routine thrombolytic group ［70.0%(21/30)， 66.7%(20/30), 96.7%(29/30) vs 53.3%(16/30)］, and the combined treatment group was higher than that of aspirin group and clopidogrel group (all P<0.05), but there was no significant difference between aspirin group and clopidogrel group (P>0.05). There was no significant difference in the incidence of adverse reactions among the four groups during treatment (P>0.05). Conclusion Pretreatment with anti-platelet aggregation drugs before intravenous thrombolysis with alteplase can increase the therapeutic effect of intravenous thrombolysis and reduce the rate of disability.