阿替普酶聯(lián)合氯吡格雷在急性缺血性輕型腦卒中患者中的應(yīng)用

明子歆

[摘要]目的 探討阿替普酶聯(lián)合氯吡格雷在急性缺血性輕型腦卒中（AIMS）患者中的應(yīng)用。方法 選取2018年1月～2019年5月我院收治的154例AIMS患者，按隨機數(shù)字表法分為觀察組和對照組，每組各77例。對照組采用常規(guī)降糖及降壓治療，同時聯(lián)合阿替普酶治療，觀察組在此基礎(chǔ)上聯(lián)合氯吡格雷治療。隨訪3個月，比較兩組的美國國立衛(wèi)生院神經(jīng)功能缺損量表（NIHSS）評分及改良Rankin量表評分、實驗室指標(biāo)、Barthel指數(shù)和日常生活活動能力（ADL）評分、不良事件。結(jié)果 觀察組治療后的NIHSS及改良Rankin量表評分低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組治療后Barthel指數(shù)和ADL評分高于治療對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。兩組治療后的白細(xì)胞計數(shù)（WBC）、血小板計數(shù)（PLT）、纖維蛋白原（FIB）比較，差異無統(tǒng)計學(xué)意義（P>0.05）。觀察組不良事件的總發(fā)生率為2.60%，低于對照組的12.99%，差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 阿替普酶聯(lián)合氯吡格雷治療AIMS患者的效果顯著，具有較高的安全性。

[關(guān)鍵詞]阿替普酶;氯吡格雷;急性缺血性輕型腦卒中;癥狀改善;安全性

[中圖分類號] R743.31? ? ? ? ? [文獻(xiàn)標(biāo)識碼] A? ? ? ? ? [文章編號] 1674-4721（2020）6（c）-0146-03

Application of Alteplase combined with Clopidogrel in patients with acute ischemic mild stroke

MING Zi-xin

Outpatient Western Medicine Office， Dandong First Hospital， Liaoning Province， Dandong? ?118000， China

[Abstract] Objective To explore the application of Alteplase combined with Clopidogrel in patients with acute ischemic mild stroke （AIMS）. Methods A total of 154 patients with AIMS admitted to our hospital from January 2018 to May 2019 were selected. According to the random number table method， they were divided into observation group and control group， with 77 cases in each group. Patients in the control group received conventional methods of lowering blood glucose and blood pressure besides Alteplase treatment. In the observation group， on the basis of the control group， Clopidogrel was added. Followed up for 3 months， the National Institute of Health stroke scale （NIHSS） score and the modified Rankin scale score， laboratory indicators， Barthel index and activity of daily living （ADL） score， and adverse events were compared in the two groups. Results The NIHSS and modified Rankin scale scores of the observation group after treatment were lower than those of the control group， and the differences were statistically significant （P<0.05）. The Barthel index and ADL score of the observation group after treatment were higher than those of the control group with statistical significances （P<0.05）. There were no significant differences in white blood cell count （WBC）， platelet count （PLT） and platelet count （FIB） between the two groups after treatment （P>0.05）. The total incidence of adverse events in the observation group was 2.60%， lower than 12.99% in the control group， and the difference was statistically significant （P<0.05）. Conclusion Alteplase combined with Clopidogrel is effective in the treatment of patients with AIMS and has a high safety.

[Key words] Alteplase; Clopidogrel; Acute ischemic mild stroke; Symptom improvement; Safety

急性缺血性輕型腦卒中（acute ischemic mild stroke，AIMS）主要是指存在輕度的神經(jīng)功能損傷的急性缺血型腦卒中患者，此類患者的美國國立衛(wèi)生院神經(jīng)功能缺損量表（National Institute of Health stroke scale，NIHSS）評分通常≤3分，且無明顯的意識障礙，部分患者由于癥狀較輕微而易喪失最佳治療時機，增大了卒中復(fù)發(fā)的風(fēng)險。當(dāng)前，應(yīng)用阿替普酶溶栓療法對患者進(jìn)行治療已成為臨床共識，此舉能夠優(yōu)化患者的顱內(nèi)微循環(huán)，并可改善其神經(jīng)功能，具有一定的療效[1]。有報道指出，在阿替普酶基礎(chǔ)上加用抗血小板藥物，能夠更好地改善預(yù)后[2]。為驗證此種綜合療法的可行性及有效性，本文通過研究阿替普酶聯(lián)合氯吡格雷在AIMS患者中的應(yīng)用效果，旨在為臨床治療提供更加科學(xué)的方案支持，現(xiàn)報道如下。……